Moderator- Dr. Thomas John
Presenter-Dr. Pradeep katwal
• 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
• CAD with single vessel disease presenting initially with
complete heart block and later with SVT.
What is ECG?
• ECG is graphical recording of electrical activity
of heart from body surface using multiple
electrode placed over the body.
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 .
• Angiography-coronary artery disease, single
vessel disease-Right coronary artery occlusion
• Stenting was done with BMS
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
• 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.
Right venticular infraction on EKG
ST elevation of 1 mm or more in lead V1 and
Failure of development of reciprocal changes
in right precodial leads.
Decrease in magnitude of ST elevation in leads
Discordant relationship of ST changes(ST
elevation in lead V1 and depression in lead
• 34 YRS OLD HYPERTENSIVE MALE
– DURING ROUTINE CHEAK UP
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
Risk of polymorphic ventricular arrhythmias
• 19 ys/F, with 5 days history of central chest pain and
fever. Her pulse rate was 74 beats/min and her
EKG Manifestations of Acute
Taller, Peaked and symmetrical T waves
Elevated Concave upwards S-T segment
without reciprocal changes
The PR segment elevation on lead AVR.
• 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
• 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
She’s taken to angiography where she’s found t
o have normal coronary arteries.
Mayo Clinic criteria for tako-tsubo
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