ICCU ECGs

1. ICCU ECGs
OCT 25,2020
DR. KAMAL MURTAZA
MD, DNB, DNB SS (PEDIATRIC CARDIOLOGY)

2. Case scenario: 1
65y/ lady
Past h/o few attacks of dizziness
Presently had a fall in bathroom and had hip fracture
Found to have bradycardia: ECG

3. 3

4. Interpretation
Complete Heart Block with ventricular rate of 45/ min.
Ventricular escape rhythm has wide QRS complexes and
abnormal T waves
Needs permanent pacemaker insertion

5. Case scenario: 2
50 y/ lady with known h/o rheumatic heart disease
Had been in heart failure, but that had been treated and she
was no longer breathless
ECG: What does it show? What questions might you ask her?

7. Interpretation
Atrial fibrillation with ventricular rate of 60-65/ min (well controlled), normal
axis, normal QRS complexes
Downward sloping ST segment best seen in leads V5-V6 (REVERSE
TICK): Means digoxin has been given
Prominent U waves in V2: Could be hypokalemia
Ask patient about her appetite: Earliest symptom of digoxin toxicity is
appetite loss with nausea+ vomiting
Hypokalemia increases toxic effects of digoxin

8. Case scenario:3
20y/ lady presented to ER with an episode of chest pain
At examination: Free of pain, normal vitals
ECG

10. Interpretation
Sinus rhythm, regular HR of app 70/ min, normal axis
Short PR interval (100ms), Prolonged QRS interval (160ms),
QTc: 460 ms
aVR shows ST elevation; I, II, aVL, aVF, V5-6 shows ST
depression
Delta waves best seen in lateral leads
WPW Type B pattern, AP location: Right posterior or
posterolateral

11. Case scenario: 4
12 years old, male child
k/c/o chronic renal failure
Admitted with respiratory distress and oliguria
ECG

13. Interpretation
Prolonged PR interval
Broad, bizarre QRS complexes merging with both preceding
P wave and subsequent T wave
Peaked P waves
Hyperkalemia

14. Case scenario: 5
47 years lady
Presented with acute onset of severe dyspnea
Vitals: 95/42, RR: 30/min, spo2: 88%
ECG

16. Interpretation
Sinus rhythm with regular HR of 102/ min, normal axis (90 deg)
Normal PR interval (160ms), Prolonged QRS (120ms), QTc: 410 ms
ST elevation: aVR
ST depression: I, II, III, V4,5,6
T invention in 111, aVR, V1,2,3
S wave lead I
RSR’ patternV1,V2
D/Ds: Pulmonary embolism/ ACS
With clinical stem of hypoxia, hypotension and pre-syncope: PE more likely

17. THANK YOU