A 73-year-old male presented with left upper and lower limb weakness. He has a history of diabetes and hypertension. On examination, his pulse was 64 beats/min, blood pressure was 160/100 mmHg, and he had left-sided hemiplegia. An ECG showed normal sinus rhythm, prolonged QT interval of 500ms, and deep anterolateral T wave inversions, which could be due to central nervous system involvement or myocardial ischemia. ECG findings associated with acute central nervous system disorders include prolonged QT interval and deeply inverted T waves in precordial leads.

1. ECG QUIZ
PROF(DR).G.SUNDARAMURTHY
M2 UNIT
DR.DILIP HARINDRAN
SECOND YEAR PG RESIDENT

2. PRESENTATION
• A 73 YEAR OLD MALE CAME WITH
COMPLAINTS OF DIFFICULTY IN USING LEFT
UPPER LIMB AND LOWER LIMB SINCE
MORNING. A KNOWN DIABETIC AND
HYPERTENSIVE.
• O/E PR - 64/MIN, BP - 160/100 MM HG,
GCS -8/15 CNS - LEFT HEMIPLEGIA.
• ECG WAS TAKEN FOR THE PATIENT WHICH
SHOWED,

4. INTERPRETATION
• NORMAL SINUS RHYTHM
• RATE - 75/MIN
• P WAVE - NORMAL MORPHOLOGY, REDUCED
VOLTAGE IN LIMB LEADS
• PR INTERVAL NORMAL
• QRS COMPLEX NORMAL MORPHOLOGY, LOW
VOLTAGE IN LIMB LEADS
• QT INTERVAL PROLONGED - 500MS AND DEEP
ANTEROLATERAL T WAVE INVERSIONS (CAN BE DUE
TO CNS INVOLVEMENT OR MYOCARDIAL
ISCHEMIA).

5. DISCUSSION
• ECG FINDINGS OF ACUTE CNS DISORDERS
INCLUDE:
1. LARGE UPRIGHT T WAVES IN PRECORDIAL LEADS
2. INCREASED QRS VOLTAGE
3. DEEPLY INVERTED T WAVES IN PRECORDIAL
LEADS
4. PROLONGED QT INTERVAL
5. PROMINENT U WAVES IN PRECORDIAL LEADS

6. • OTHERS FINDINGS INCLUDE:
1. T WAVE NOTCHING
2. LOSS T WAVE AMPLITUDE
3. DIFFUSE ST SEGMENT ELEVATION
4. ABNORMAL Q WAVES
5. RHYTHM ABNORMALITIES LIKE AF, VT, SINUS
BRADYCARDIA OR TACHYCARDIA CAN
OCCUR.

7. • ECG CHANGES ASSOCIATED WITH ACUTE CNS
EVENTS CAN MIMIC -
1. ACUTE MYOCARDIAL INFARCTION
2. LEFT VENTRICULAR HYPERTROPHY
3. RIGHT VENTRICULAR HYPERTROPHY
4. PERICARDITIS
5. ANTIARRHYTHMIC DRUG EFFCTS

8. FIND THE IMPOSTER

9. ANSWER
• TRACINGS A, B AND C SHOW ATRIAL FIBRILLATION
WITH IRREGULARLY IRREGULAR RHYTHMS;
FIBRILLATORY WAVES OF VARYING AMPLITUDE AND
MORPHOLOGY; ABSENCE OF DISCRETE P WAVES.
• TRACING D SHOWS MAT. IT USUALLY PRESENTS
WITH ATRIAL RATE OF >100BPM, 3 OR MORE
DIFFERENT P WAVE MORPHOLOGIES, AND VARYING
PP AND PR INTERVAL. DEFINITE P WAVES AND
ATRIAL DEPOLARIZATIONS ARE NOTED WHICH ARE
NOT THERE IN A, B AND C.