ECG Jeopardy
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This document provides an overview of ECG criteria for administering thrombolysis in patients presenting with chest pain. It discusses the key criteria including characteristic pain lasting over 30 minutes up to 12 hours that is not relieved by nitrates, as well as ECG changes such as ST elevation of 1mm or greater in two limb leads or 2mm or greater in two or more adjacent chest leads. It also notes that the 12-lead ECG may appear normal in some patients with unstable angina.
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Ecg commentary from saudi arabia 2004 white
This document contains a collection of ECG recordings and cases presented and discussed by Dr. Samir Morcos Rafla at the 2004 Saudi Arabia Conference where he was a speaker and chairperson. It includes cases of pregnant women with atrial tachycardia, infants with dilated cardiomyopathy and long QT syndrome, children with arrhythmias, and neonates with bradycardia. Diagnoses discussed include junctional ectopic tachycardia, Brugada syndrome, torsades de pointes, complete heart block, and anomalous left coronary artery. Management strategies involve medications like beta blockers, flecainide, and pacemakers.
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Ischamic stroke
Michael, a 61-year-old lawyer, experienced sudden onset slurred speech and weakness on the left side of his body while eating breakfast. He was diagnosed with hypertension and atrial fibrillation. At the hospital, tests showed signs of an acute ischemic stroke in the right middle cerebral artery. Michael received intravenous tissue plasminogen activator and underwent a mechanical thrombectomy procedure to remove the clot, with full recovery. He was discharged on a prevention regimen including antiplatelet therapy and lifestyle modifications.
Brugada Syndrome, Sbcc 2012
Brugada Syndrome is a genetic cardiac condition characterized by abnormal ECG patterns and risk of sudden cardiac death. It is caused by mutations in the SCN5A gene which encodes cardiac sodium channels. Patients typically present with syncope or sudden death and have a distinctive pattern on ECG of ST segment elevation in leads V1-V3. Risk stratification focuses on history of symptoms like syncope as inducible arrhythmias on electrophysiological study have poor predictive value. Treatment involves medical management with quinidine or device therapy with an ICD for high-risk patients. Lifestyle modifications like avoiding fever or medications that affect sodium channels are also recommended.
Brugada
This document provides information on a case of Brugada syndrome in a 70-year-old female patient. Key details include:
- The patient presented with a month of fever and breathlessness and was referred for ECG changes. Exams found wheezing and tremors.
- Tests included a normal echocardiogram and negative troponin. A Holter monitor found no arrhythmias.
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Ecg commentary from saudi arabia 2004 white
This document contains a collection of ECG recordings and cases presented and discussed by Dr. Samir Morcos Rafla at the 2004 Saudi Arabia Conference where he was a speaker and chairperson. It includes cases of pregnant women with atrial tachycardia, infants with dilated cardiomyopathy and long QT syndrome, children with arrhythmias, and neonates with bradycardia. Diagnoses discussed include junctional ectopic tachycardia, Brugada syndrome, torsades de pointes, complete heart block, and anomalous left coronary artery. Management strategies involve medications like beta blockers, flecainide, and pacemakers.
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Michael, a 61-year-old lawyer, experienced sudden onset slurred speech and weakness on the left side of his body while eating breakfast. He was diagnosed with hypertension and atrial fibrillation. At the hospital, tests showed signs of an acute ischemic stroke in the right middle cerebral artery. Michael received intravenous tissue plasminogen activator and underwent a mechanical thrombectomy procedure to remove the clot, with full recovery. He was discharged on a prevention regimen including antiplatelet therapy and lifestyle modifications.
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Brugada Syndrome is a genetic cardiac condition characterized by abnormal ECG patterns and risk of sudden cardiac death. It is caused by mutations in the SCN5A gene which encodes cardiac sodium channels. Patients typically present with syncope or sudden death and have a distinctive pattern on ECG of ST segment elevation in leads V1-V3. Risk stratification focuses on history of symptoms like syncope as inducible arrhythmias on electrophysiological study have poor predictive value. Treatment involves medical management with quinidine or device therapy with an ICD for high-risk patients. Lifestyle modifications like avoiding fever or medications that affect sodium channels are also recommended.
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This document provides information on a case of Brugada syndrome in a 70-year-old female patient. Key details include:
- The patient presented with a month of fever and breathlessness and was referred for ECG changes. Exams found wheezing and tremors.
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- The document then provides background on Brugada syndrome, including its genetic basis, ECG patterns, diagnosis, management with ICDs and drugs, and drugs to avoid due to risk of arrhythmias.
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CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity. ECG interpretation: NSTEMI
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Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
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- Long QT syndrome (LQTS) is a condition where a patient's EKG shows abnormal heart rhythms and susceptibility to rapid and chaotic heartbeats. This can cause fainting or seizures.
- Fainting, also known as syncope, is the temporary loss of consciousness caused by low blood flow to the brain. It can be triggered in LQTS patients by startling events or changes in mood like excitement or fear.
- Before losing consciousness, an LQTS patient may experience blurred vision, lightheadedness, or weakness. Startling sounds or mood changes are common triggers for fainting in people with LQTS.
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This document discusses the evaluation and management of acute chest pain, which can be caused by conditions like angina, myocardial infarction (MI), or other musculoskeletal and gastrointestinal issues. Key points include:
- Taking a history, examining vital signs, performing an ECG and cardiac biomarkers to determine if the pain is cardiac or non-cardiac in nature.
- For suspected acute coronary syndromes like unstable angina or NSTEMI, treatment involves antiplatelet therapy, anticoagulation, nitrates, beta blockers and revascularization if needed.
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Guillain - Barre syndrome after acute myocardial infarction: A rare presentat...
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2. Atypical angina is defined as having two of the four typical criteria. The likelihood of angina increases with age and is generally higher in men.
3. Non-cardiac causes of chest pain that should be considered include musculoskeletal pain, psychogenic factors, and gastrointestinal issues like acid reflux. Taking a thorough history is important to determine the underlying cause of chest pain.
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This document contains 10 ECG recordings from patients presenting with various symptoms, along with background information on each case. The doctor is asking for interpretations of each ECG and recommendations for further evaluation or treatment. The cases include patients with chest pain, palpitations, breathlessness, dizzy spells, and one patient who collapsed.
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CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity. ECG interpretation: NSTEMI
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Focus on those which occur most commonly
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ECG interpretation: NSTEMI
Recognise the ECG patterns which occur in NSTEMI
Focus on those which occur most commonly
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The document summarizes a presentation on electrocardiographic passing phenomena given at a cardiology conference. It includes 10 case studies demonstrating different types of passing phenomena, such as accelerated junctional rhythm, bigeminy, and sinus arrhythmia. It discusses the historical discovery of these phenomena, how they are analyzed and classified, common target diseases they may indicate but not necessarily be related to, and how reassuring patients can be an effective therapy. Statistics on the study subjects are provided, such as average age and percentages of occupations and main complaints. Serial electrocardiograms are presented for each case study and management primarily involved reassurance without medical intervention.Approach to Channelopathies ppt
This document discusses different types of channelopathies, which are inherited arrhythmogenic diseases caused by mutations in ion channel genes. It summarizes the definitions, epidemiology, clinical manifestations, risk stratification approaches, and management recommendations for several major channelopathies:
- Long QT syndrome is associated with prolonged cardiac repolarization and can cause syncope or cardiac arrest. Risk stratification considers clinical factors and genetic testing, and management includes beta-blockers and ICDs.
- Brugada syndrome causes ST segment elevation and is a common cause of sudden cardiac death. Risk is assessed based on symptoms and ECG patterns, and ICDs are often recommended for high-risk patients.
- Cate
Myocardial infarction clinical picture, investigations European guidlines 2012
This document discusses myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle cells due to reduced blood flow. The two main types of MI are transmural, affecting the full thickness of the heart wall, and nontransmural, affecting only part of the wall. Symptoms of MI can include chest pain, shortness of breath, nausea, and sweating. Diagnosis involves electrocardiogram (EKG) showing elevated ST segments or new Q waves, and blood tests showing elevated cardiac troponin or CK-MB levels. Early diagnosis and treatment are important to reduce risk of complications and death.
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Erick Carlson, MD presents "Exercise and the Heart" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
Guillain–Barré syndrome after acute myocardial infarction: A rare presentation
The association of acute coronary syndrome with any immunological mediated polyradiculopathy like Guillain–Barré syndrome is very rare. We report such a rare association of acute myocardial infarction and Guillain–Barré syndrome. Our patient underwent primary angioplasty successfully, but developed respiratory failure while in hospital. While the difficulty in weaning off from ventilator a suspicion of neuromuscular disease was made. The further investigations, including nerve conduction study confirmed a diagnosis of Guillain–Barré syndrome. Despite treatment, the patient died secondary to multi-organ dysfunction. Our case is 4th reported in the literature without use of any thrombolytic agent for such association.
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...
Hypocalcemia induced camel-hump t-wave, tee-pee sign, and bradycardia in a ca...YasserMohammedHassan1
Rationale: Electrocardiographic is a fundamental tool for a cardiologist, critical care physician, and emergency medicine specialist. The electrolyte imbalance is a very important entity in clinical medicine management. Camel-hump T-wave and the Tee-Pee sign, recently; Wavy triple and Wavy double signs of hypocalcemia (Yasser’s sign) are electrocardiographic findings linked to electrolyte deficiencies. Patient concerns: A middle-aged male car-painter patient presented to the emergency department with atypical severe twisting chest pain, hypocalcemia, hypokalemia, and hypernatremia.
Diagnosis: Hypocalcemia-induced Camel-hump T-wave, Tee Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign), and bradycardia in a car- painter. Interventions: Electrocardiography, arterial blood gases, oxygenation, and echocardiography. Lessons: The dramatic reversal of Camel-hump T-Wave, Tee-Pee sign, Wavy double sign of hypocalcemia (Yasser’s sign) after calcium gluconate injection interpret that these signs were due to hypocalcemia. The twisting chest pain and its limited disappearance immediately after calcium gluconate injection indicate the pain can be named as “chest tetany”. Non-atropine bradycardia response is evidence that the management of the cause of bradycardia sometimes is essential e.g. hypocalcemia in the current case. Outcomes: There was a dramatic response of both clinical and electrocardiography including Camel-hump T-wave, Tee Pee sign, the wavy double sign of hypocalcemia, and bradycardia.
Long QT Syndrome Associated Syncope
Long QT Syndrome Associated Syncope
- Long QT syndrome (LQTS) is a condition where a patient's EKG shows abnormal heart rhythms and susceptibility to rapid and chaotic heartbeats. This can cause fainting or seizures.
- Fainting, also known as syncope, is the temporary loss of consciousness caused by low blood flow to the brain. It can be triggered in LQTS patients by startling events or changes in mood like excitement or fear.
- Before losing consciousness, an LQTS patient may experience blurred vision, lightheadedness, or weakness. Startling sounds or mood changes are common triggers for fainting in people with LQTS.
Patient of Myotonic Dystrophy presented with Celebellar Infarction
A 52-year-old man presented with vertigo and lower limb weakness. Examination found expressionless face, ptosis, hypophonic speech, reduced muscle bulk and tone distally, percussion and grip myotonia. Investigations showed features of myotonic dystrophy including EMG findings. He was diagnosed with myotonic dystrophy, diabetes, hypertension, and ischemic heart disease. He was counseled on his condition and genetic risks and advised follow up.
Acute chest pain medicos notes-com
This document discusses the evaluation and management of acute chest pain, which can be caused by conditions like angina, myocardial infarction (MI), or other musculoskeletal and gastrointestinal issues. Key points include:
- Taking a history, examining vital signs, performing an ECG and cardiac biomarkers to determine if the pain is cardiac or non-cardiac in nature.
- For suspected acute coronary syndromes like unstable angina or NSTEMI, treatment involves antiplatelet therapy, anticoagulation, nitrates, beta blockers and revascularization if needed.
- For STEMI, prompt treatment involves aspirin, clopidogrel, thrombolytics if eligible, and managing any arrhythmias or mechanical complications
STEMI, N-STEMI, and Everything else
This document provides information on STEMI, NSTEMI, and STEMI mimics for paramedics. It discusses the importance of accurate 12-lead ECG interpretation for identifying STEMIs to reduce door-to-balloon times and improve outcomes. It outlines criteria for calling a "Code STEMI" to activate the cardiac catheterization lab as well as situations where a "Medical Stat" or routine transport would be more appropriate based on the 12-lead findings. The goal is to minimize false STEMI activations while still rapidly identifying true STEMIs.
St elevation myocardial infarction
This document defines STEMI and describes the presentation, diagnosis, and management of a patient experiencing an ST elevation myocardial infarction through electrocardiogram findings, fibrinolytic therapy, percutaneous coronary intervention, and post-procedure care. Reperfusion therapy options like fibrinolysis with streptokinase or alteplase and primary PCI are discussed. Guidelines for long-term secondary prevention with medications and lifestyle changes are also reviewed.
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This document discusses the diagnosis and management of acute coronary syndrome (ACS). It describes the typical symptoms of ACS including chest pain and electrocardiogram (ECG) changes. It outlines the use of biochemical markers like troponin levels to differentiate between ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Management involves reperfusion therapies like percutaneous coronary intervention (PCI) or thrombolysis for STEMI, along with antiplatelet and anticoagulant medications. For NSTEMI/UA patients, management depends on risk stratification using tools like the TIMI risk score.
Presentation on mi
A 55-year-old male smoker and alcoholic presented with chest pain and was diagnosed with a myocardial infarction based on electrocardiogram and cardiac enzyme changes. He received treatment including aspirin, nitroglycerin, morphine, and streptokinase thrombolysis and was admitted to the intensive care unit. Nursing care focused on monitoring, providing pain relief, and health teaching prior to discharge.
STEMI case scanarios
1. This document discusses several scenarios involving patients experiencing potential heart attacks and the appropriate emergency response, including ECG diagnosis and management plans.
2. Per NHS QIS standards, the goal is to minimize time from ECG to balloon (PPCI) or needle (thrombolysis). If PPCI isn't possible within 40 minutes, thrombolysis may be administered instead.
3. One scenario details a patient receiving thrombolysis more than 90 minutes after symptoms due to long transport time, who then underwent PPCI at the hospital with first balloon inflation 23 minutes later, meeting NHS standards.
case scenario 1-chest pain
- A 54-year-old man presented with crushing chest pain and difficulty breathing.
- An ECG showed ST-elevation consistent with an acute anterior wall myocardial infarction (STEMI).
- Initial management included fibrinolytic therapy (e.g. streptokinase) within 12 hours of symptom onset to reperfuse the occluded coronary artery and reduce mortality.
Acute coronary syndrome
This document presents a case study of a 28-year-old male who presented to the emergency department with chest pain. His initial troponin level was negative but later increased. His ECG showed ST elevations. He was diagnosed with an ST elevation myocardial infarction (STEMI) based on his symptoms, elevated troponin level, and ECG changes. He was admitted and managed medically with aspirin, clopidogrel, heparin, oxygen, nitroglycerin, and morphine as needed. He had an uneventful recovery and was discharged after 5 days.
Chest Pain- Differential Diagnosis
This document discusses the differential diagnosis of chest pain by describing various cardiac and non-cardiac causes. It outlines key factors in the history and physical exam that can help determine if chest pain is typical angina, atypical angina, or non-anginal. Common cardiac causes discussed include acute coronary syndromes, aortic dissection, and pericarditis. Common non-cardiac causes discussed include pulmonary embolism, pneumonia, gastrointestinal issues like pancreatitis and peptic ulcer disease. Diagnostic tests for different conditions are also mentioned.
Family medicine presentation1120111final
A 28-year-old school teacher and mother of 3 children presented with chest pain and palpitations. Her ECG showed normal sinus rhythm. A 53-year-old male with a history of pontine hemorrhage presented with chest pain. His two sets of cardiac enzymes were normal and his ECG showed NSR with LVH and LV strain pattern. A 65-year-old male with a history of recurrent heart failure and non-ischemic cardiomyopathy was admitted to the CCU and his ECG showed NSR with LBBB.
APHRS 2019 Case Report Presentation Wellen's syndrome meets Brugada phenocopy
A 37-year-old male presented with chest pain and was found to have abnormal ECG patterns. His initial ECG showed a pattern resembling Wellen's syndrome type B (deeply inverted, symmetrical T-waves). However, after angiography revealed a 99% blockage in his LAD coronary artery, his ECG changed and no longer resembled Wellen's syndrome. This case demonstrates that ECG patterns resembling channelopathies like Brugada syndrome can actually be phenocopies caused by underlying ischemia, emphasizing the importance of serial ECGs and evaluating for ischemic causes first.
interesting ECG,CXR,ECHO
The document provides information about various cardiac conditions that can be identified on ECGs, echocardiograms, chest x-rays and other cardiac tests. It describes the findings and diagnoses for 12 different clinical cases, including polymorphic atrial tachycardia, preexcited atrial fibrillation, AV nodal reentrant tachycardia, Brugada syndrome, R-on-T phenomenon, hypokalemia, catecholaminergic polymorphic ventricular tachycardia, atrial lead dislodgment, atrial flutter, pulmonary and aortic pressures in ventricular septal defect, and intra-aortic balloon pump positioning.
Cerebral Venous Sinus Thrombosis (CVST) Case Report
Dr. Ahmed Tanjimul Islam.
MSc. (Leeds, England); MD (Neurology)
Rajshahi Medical College Hospital, Bangladesh.
01554333026
Acute Coronary Syndrome
The document describes several patient cases presenting with chest pain. The first case is a 45-year-old man with a history of angioplasty who presents with chest pain on walking. The second case is a 55-year-old man with chest pain while sitting. The third case is a 63-year-old man with chest pain while gardening. The fourth case is a 65-year-old woman with sudden chest pain. The fifth case is a 60-year-old man with severe chest pain for 2 hours. The document then discusses diagnoses, risk factors, management, and treatment for acute coronary syndromes.
MYOCARDIAL INFARCTION
A 48-year-old male patient arrived at the emergency room accompanied by friends with chest pain. He had been playing soccer and experienced pain in his chest on three occasions. The patient smokes 5 cigars per day and does not engage in regular physical activity. His father had died of a heart attack at age 55. The patient's chest pain was described as oppressive and radiating to his left arm. His medical evaluation found elevated blood pressure, obesity, and an unhealthy lifestyle. The case analysis indicates the patient likely suffered a myocardial infarction due to risk factors including age, family history of heart disease, smoking, obesity, hypertension, and sedentary lifestyle.
Topik 6 - ECG in clinical practica (Advanced ECG).pdf
This document presents 8 clinical cases involving ECG interpretations by a junior doctor supervised by an expert. Each case provides background on the patient and their symptoms, the junior doctor's interpretation, and the expert's analysis of ECG abnormalities and recommended actions. The expert identifies issues such as lead misplacement, arrhythmias mimicking STEMI, and subtle signs of ACS. Through these cases, the expert aims to teach the junior doctor to carefully examine ECGs, consider alternative diagnoses, and treat concerning abnormalities promptly while continuing to improve skills in ECG interpretation.
Acute coronary syndrome
Acute Coronary Syndrome (ACS) refers to a range of conditions caused by reduced blood flow in the coronary arteries. It includes Unstable Angina (UA), Non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). ACS is diagnosed based on electrocardiogram (ECG) findings and cardiac enzyme levels. STEMI shows ST elevations and enzyme elevations, while NSTEMI shows ST depressions/inversions and enzyme elevations without ST elevations. UA shows non-specific ECG changes and normal enzymes. Risk stratification systems like the TIMI score are used for NSTEMI/UA patients to guide management, which may
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APHRS 2019 Case Report Presentation Wellen's syndrome meets Brugada phenocopy
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2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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ECG Jeopardy
- 1. ECG Jeopardy Charlie Bloe Clinical Manager, CCU, Raigmore Hospital
- 2. Site of Infarct Anterior MI Inferior MI
- 4. Site of Infarct Anterior MI Inferior MI
- 8. Sufficient ECG criteria to administer thrombolysis in this patient with chest pain for last 90 minutes?
- 10. Sufficient ECG criteria to administer thrombolysis? Yes No
- 11. ECG criteria for thrombolysis • Characteristic Pain • Gradual onset of pain (>30 mins < 12 hours) • Pain not relieved by nitrates • ECG changes • 1mm or > ST elevation in 2 limb leads • 2 mm or > ST elevation in 2 or more adjacent chest leads • New left bundle branch block
- 13. Case study • 64 year old man with 1 hour of chest pain. Wife dialled 999. Friday 6pm. • Recent bout of Flu. • Severe, heavy, central pain with radiation to jaws and arms. • Pale and sweaty. • Lives 5 minutes from Raigmore Hospital.
- 17. What would you do? Thrombolysis if no contraindications ‘Scoop and Run’
- 18. In the early stages of STEMI each 1 minute delay to thrombolysis reduces life expectancy by: 1 day 11 days
- 19. The 12-lead ECG in a patient with Unstable Angina may appear normal? True False
- 20. STEMI or not STEMI? • 45 year old man with 3 days of chest pain. • First aware of it while playing 5-a-side football. • Varying intensity over last 3 days but there pretty much all of the time. • Feels like a pulled muscle. • No radiation. • A bit pale but otherwise looks well.
- 22. STEMI? Yes No
- 23. Pericarditis ECG changes: • ST elevation • Upward concavity • Widespread • Notching at end of QRS • Not evolving • No Q wave • Pain often pleuritic in nature, worse on inspiration.
- 25. What rhythm?
- 26. What rhythm? VF – cardiac arrest Atrial Flutter
- 27. What rhythm?
- 28. Case study • 32 year old man. • No significant PMH. Smoker. • Chest pain for about 8 hours. • Dull central ache. No radiation. • ECG #1 recorded - not transmitted to CCU.
- 29. ECG 1 at 1.15am by GP
- 30. ECG within normal limits Anterior STEMI
- 31. ECG 1 at 1.15am by GP
- 32. Case study • Arrives in AMAU at Raigmore Hospital 1 hour later. • ECG #2 recorded.
- 33. ECG 2 at 2.30am
- 34. ECG within normal limits Anterior lateral STEMI
- 35. ECG 2 at 2.30am
- 36. Case study • 59 year old lady. • Hypertension and smoker. • Ischaemic chest pain for 2 hours. • Lives in isolated croft 2 hours from Raigmore. • Call made in January 2010. • When Paramedics arrived 2 feet of snow outside her house!
- 38. Diagnosis? Inferior MI with complete heart block. Inferior MI with 2:1 block.
- 43. What proportion of all strokes are attributable to Atrial Fibrillation (AF) ?
- 44. 30-40% 15-20%
- 45. Record a 12-Lead ECG in all patients that have an irregular pulse!
- 46. Case study • 50 year old man from Aviemore complaining of central chest pain. • Feels like trapped wind. • Diagnostic ECG machine querying anterior MI.
- 48. Anterior STEMI – advise Thrombolysis. Normal ECG – advise he has a fart.
- 52. Second degree heart block Type II Complete heart block
- 54. Fast and wide rhythm. Is it Ventricular Tachycardia (VT)?
- 56. VT? Yes No
- 58. What type of block RBBB or LBBB?
- 60. Right bundle branch block (RBBB) Left bundle Branch block (LBBB)
- 62. Cardiac Axis
- 64. Right axis deviation Left axis deviation
- 66. 70 year old man with dyspnoea
- 68. 70 year old man with dyspnoea
- 72. CASE 4