SOME INTRESTING ECG

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SOME INTRESTING ECG

  1. 1. INTERESTING ECGS Moderator- Dr. Thomas John Presenter-Dr. Pradeep katwal
  2. 2. ECG included • SINUS EXIT BLOCK type II • Anteroseptal wall myocardial infraction • SVT with aberrant conduction • WPW syndrome • Inferior wall MI with right ventricular extension • Burgada syndrome • Acute pericarditis • Takasubo cardiomyopathy • Hypothermia • CAD with single vessel disease presenting initially with complete heart block and later with SVT.
  3. 3. What is ECG? • ECG is graphical recording of electrical activity of heart from body surface using multiple electrode placed over the body.
  4. 4. The Normal Conduction System
  5. 5. All Limb Leads
  6. 6. Precordial Leads
  7. 7. Interpretation • Systematic approach to reading EKGs : • Rate • Rhythm (including intervals and blocks) • Axis • Hypertrophy • Ischemia
  8. 8. Waveforms The electrical pattern of the cardiac cycle shows waves and intervals.
  9. 9. Electrical axis deviation of heart
  10. 10. Case 1 • 68 ys old male presented in emergency with history of progressive shortness of breath and generalized swelling of body. • Vitals – Pulse-32/min – B.P.-90/60 mm hg
  11. 11. INTITIAL ECG
  12. 12. • SINUS EXIT BLOCK type II • PP intervals fairly constant (unless sinus arrhythmia present) until conduction failure occurs • The pause is approximately twice the basic PP interval
  13. 13. • 2ND DEGREE AV BLOCK
  14. 14. • S.creat: 4.5 mg% • S. potassium: 7.1 mEq/l • Urea : 164 mg/dl • DIGNOSIS- CHRONIC KIDNEY DISEASE SATGE 5- METABOLIC ACIDODIS, HYPERKALEMIA, ANEMIA OF CHRONIC DISEASE
  15. 15. CASE 2 • 76 Yrs old male, emergency • C/O – Epigastric pain * 2 days – Vomiting *2 episodes • Vitals – Pulse-72/min – B.P.-100/68 mmhg
  16. 16. Initial ECG
  17. 17. At 12 p.m. • Call was given for sudden onset shortness of breath. – pulse rate- 280/min • ECG showed-
  18. 18. ecg2
  19. 19. VT versus SVT with aberrancy • Very broad complexes (>160ms) • A V dissociation • Capture beats • Fusion beats Positive or negative concordance throughout the chest leads, i.e. leads • V1-6 show entirely positive (R) or entirely negative (QS) complexes, with no RS complexes seen. • Brugada’s sign – The distance from the onset of the QRS complex to the nadir of the S-wave is > 100ms • Josephson’s sign – Notching near the nadir of the S-wave • RSR’ complexes with a taller left rabbit ear .
  20. 20. • Angiography-coronary artery disease, single vessel disease-Right coronary artery occlusion • Stenting was done with BMS
  21. 21. ECG3
  22. 22. Case 3 16 yrs old male without significant past medical history presented with H/O palpitation on and off. Vitals • Pulse-76/min
  23. 23. ECG2
  24. 24. ECG criteria include all of the following Short PR interval (<0.12s) Initial slurring of QRS complex (delta wave) representing early ventricular activation through normal ventricular muscle in region of the accessory pathway  Prolonged QRS duration (usually >0.10s)  Secondary ST-T changes due to the altered ventricular activation sequence
  25. 25. ECG1
  26. 26. AVRT With Orthodromic Conduction • Rate usually 200 – 300 bpm. • Wide QRS complexes due to abnormal ventricular depolarisation via accessory pathway.
  27. 27. CASE 4 • 68 yrs old male –Chest pain since 4 HOURS –a/w Shortness of breath, vomiting Vitals –Pulse-86 JVP-raised –B.P.-100/60 mmhg
  28. 28. ECG 1
  29. 29. observe • ST elevation in V1 • ST elevation in lead III > lead I
  30. 30. ECG 2 • RIGHT SIDE ECG
  31. 31. • Right ventricular infarction is confirmed by the presence of ST elevation in the right-sided leads (V3R- V6R). The most useful lead is V4R, which is obtained by placing the V4 electrode in the 5th right intercostal space in the midclavicular line.
  32. 32. Right venticular infraction on EKG ST elevation of 1 mm or more in lead V1 and lead V4R. Failure of development of reciprocal changes in right precodial leads. Decrease in magnitude of ST elevation in leads V1-V5 Discordant relationship of ST changes(ST elevation in lead V1 and depression in lead V2)
  33. 33. CASE 5 • 34 YRS OLD HYPERTENSIVE MALE – ASYMPTOMATIC – DURING ROUTINE CHEAK UP
  34. 34. Diagnosis
  35. 35. Burgada syndrome St-segment elevation in V1–V3 in sinus rhythm Elevated ST segment (≥2 mm) descends with an upward convexity to an inverted T wave Provoked with the sodium channel-blocking drugs Risk of polymorphic ventricular arrhythmias
  36. 36. CASE 6 • 19 ys/F, with 5 days history of central chest pain and fever. Her pulse rate was 74 beats/min and her ECG showed-
  37. 37. EKG Manifestations of Acute pericarditis Sinus tachycardia Taller, Peaked and symmetrical T waves Elevated Concave upwards S-T segment without reciprocal changes The PR segment elevation on lead AVR.
  38. 38. • Stage I everything is UP (i.e., ST elevation in almost all leads - see below) • Stage II Transition ( i.e., "pseudonormalization"). • Stage III Everything is DOWN (inverted T waves). • Stage IV Normalization
  39. 39. Case -7 • 63 year old lady is brought Emergency with central crushing chest pain. • She has no previous medical history and was in the mortuary to see the body of her son who’d just died from a subarachnoid haemorrhage..
  40. 40. ECG
  41. 41. She’s taken to angiography where she’s found t o have normal coronary arteries.
  42. 42. Mayo Clinic criteria for tako-tsubo cardiomyopathy 1. New ECG changes (St elevation or T wave inversion) or moderate troponin rise. 2. Transient akinesis / dyskinesis of left ventricle (apical and mid-ventricular segments) with regional wall abnormalities extending beyond a single vascular territory. 3. Absence of coronary artery stenosis >50% or culprit lesion.
  43. 43. Left ventriculogram
  44. 44. CASE 8 • 45 yrs old male, following exposure during a cold winter night as a result of alchohol intoxication was brought to ER.
  45. 45. ECG
  46. 46. • Sinus Bradycardia • Low amplitude P waves • Increased venticular activation time • HUMP LIKE DEFECTION of the distal limb of QRS complex with S-T segment: OSBORN W AVES • Prolonged Q-Tc interval
  47. 47. Thank you

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