Ecg quiz
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This document contains an ECG quiz that tests the reader's ability to interpret electrocardiograms and diagnose cardiac conditions. It includes 10 multiple choice questions about various ECG readings showing conditions like acute myocardial infarction in different areas of the heart, pericarditis, effects of thrombolysis, and more. The questions aim to evaluate the reader's skill in locating areas of injury, categorizing vessel disease, differentiating disease mimics, and assessing risk of heart block.
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ECG CHALLENGE
This document provides descriptions of various ECG patterns and cardiac conditions:
- It describes limb lead reversal showing a sine wave pattern typical of hyperkalemia. Calcium gluconate and other treatments are recommended.
- Accelerated idioventricular rhythm is defined as having a rate between 50-100 bpm and being a type of slow ventricular tachycardia that does not typically require treatment.
- Atrial flutter with a 4:1 conduction is described as typical or atypical, with atypical often occurring after surgeries. Atrial flutter can be cardioverted with the least amount of energy.
- Several other conditions are briefly defined such as complete heart block, dextro
Ecg test 2
This document contains an ECG test with multiple questions and answers. It discusses cases of:
1. A 60-year-old patient with diabetes, hypertension and chest pain, showing an anterior STEMI with inferior ischemia.
2. A 55-year-old woman with shortness of breath and fatigue, showing a low-voltage ECG and echocardiogram revealing pericardial effusion due to severe hypothyroidism.
3. A 60-year-old with chest pain, showing an anteroseptal STEMI with diffuse ischemia.
ECG: Quiz
This document contains ECG readings and descriptions of various cardiac conditions including: multifocal atrial tachycardia, atrial flutter with 2:1 AV block, paroxysms of atrial tachycardia, ventricular tachycardia with AV dissociation, inferior wall myocardial infarction, sinus rhythm with atrial ectopics and complete heart block, acute inferior myocardial infarction, polymorphic ventricular tachycardia, and wide complex tachycardia suggestive of left anterior descending artery involvement. The document aims to teach identification of cardiac conditions based on ECG features.
Ecg in acs
The document discusses electrocardiograms (ECGs) in the context of acute coronary syndrome. It begins by describing the normal conduction system and the 12 standard ECG leads. It then explains how ECGs are recorded and the positioning of limb and precordial leads. The document discusses ST segments, T waves, and how to evaluate for ST elevations. It defines acute coronary syndrome and describes the classifications of ST-elevation MI, non-ST-elevation MI, and unstable angina based on ECG and cardiac enzyme findings. Specific ECG patterns for lateral, inferior, septal, and posterior wall MIs are also shown.
Localisation of Myocardial Infarction
Localising MI with ECG is a clinical skill. The culprit artery involved can be identified with ECG even without coronary angiography.
Ecg !
1. The document describes 4 ECG findings from patients presenting with various symptoms. The first case shows ventricular bigeminy in a patient with chest pain. The second case shows sinus tachycardia with S1Q3T3 pattern in a bedridden patient with breathlessness, indicating pulmonary embolism. The third case shows ventricular tachycardia in a patient recently diagnosed with myocardial infarction. The fourth case provides the Brugada criteria used to diagnose Brugada syndrome.
Wide complex tachycardia drneeraj
This document discusses criteria for differentiating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) using electrocardiograms (ECGs) of patients presenting with wide complex tachycardia. It outlines definitions of VT and SVT, as well as diagnostic criteria including Brugada criteria, the lead aVR algorithm, and the RWPT (R wave to peak time) criterion. The document then analyzes ECGs of two case studies, concluding that the first is VT and the second is SVT with aberrant conduction based on application of the discussed criteria. It recognizes Prevost and Batelli for inventing defibrillation in 1899 by discovering electric shocks could
Bradyarrhythmias
Dr. Abraham discusses sinus node dysfunction and atrioventricular block. Key points include:
- The sinus node is usually located in the right atrium and receives blood supply from the right coronary artery or left circumflex artery.
- Symptoms of sinus node dysfunction range from asymptomatic ECG changes to tachycardia, bradycardia, and tachy-brady syndrome.
- Treatment options include pharmacotherapy with drugs like atropine or theophylline for short term use, and pacemaker implantation for long term treatment of sinus node disease.
- The atrioventricular node receives innervation from the arteries of Koch and shows minimal autonomic innervation. AV block can be first,
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ECG CHALLENGE
This document provides descriptions of various ECG patterns and cardiac conditions:
- It describes limb lead reversal showing a sine wave pattern typical of hyperkalemia. Calcium gluconate and other treatments are recommended.
- Accelerated idioventricular rhythm is defined as having a rate between 50-100 bpm and being a type of slow ventricular tachycardia that does not typically require treatment.
- Atrial flutter with a 4:1 conduction is described as typical or atypical, with atypical often occurring after surgeries. Atrial flutter can be cardioverted with the least amount of energy.
- Several other conditions are briefly defined such as complete heart block, dextro
Ecg test 2
This document contains an ECG test with multiple questions and answers. It discusses cases of:
1. A 60-year-old patient with diabetes, hypertension and chest pain, showing an anterior STEMI with inferior ischemia.
2. A 55-year-old woman with shortness of breath and fatigue, showing a low-voltage ECG and echocardiogram revealing pericardial effusion due to severe hypothyroidism.
3. A 60-year-old with chest pain, showing an anteroseptal STEMI with diffuse ischemia.
ECG: Quiz
This document contains ECG readings and descriptions of various cardiac conditions including: multifocal atrial tachycardia, atrial flutter with 2:1 AV block, paroxysms of atrial tachycardia, ventricular tachycardia with AV dissociation, inferior wall myocardial infarction, sinus rhythm with atrial ectopics and complete heart block, acute inferior myocardial infarction, polymorphic ventricular tachycardia, and wide complex tachycardia suggestive of left anterior descending artery involvement. The document aims to teach identification of cardiac conditions based on ECG features.
Ecg in acs
The document discusses electrocardiograms (ECGs) in the context of acute coronary syndrome. It begins by describing the normal conduction system and the 12 standard ECG leads. It then explains how ECGs are recorded and the positioning of limb and precordial leads. The document discusses ST segments, T waves, and how to evaluate for ST elevations. It defines acute coronary syndrome and describes the classifications of ST-elevation MI, non-ST-elevation MI, and unstable angina based on ECG and cardiac enzyme findings. Specific ECG patterns for lateral, inferior, septal, and posterior wall MIs are also shown.
Localisation of Myocardial Infarction
Localising MI with ECG is a clinical skill. The culprit artery involved can be identified with ECG even without coronary angiography.
Ecg !
1. The document describes 4 ECG findings from patients presenting with various symptoms. The first case shows ventricular bigeminy in a patient with chest pain. The second case shows sinus tachycardia with S1Q3T3 pattern in a bedridden patient with breathlessness, indicating pulmonary embolism. The third case shows ventricular tachycardia in a patient recently diagnosed with myocardial infarction. The fourth case provides the Brugada criteria used to diagnose Brugada syndrome.
Wide complex tachycardia drneeraj
This document discusses criteria for differentiating between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) using electrocardiograms (ECGs) of patients presenting with wide complex tachycardia. It outlines definitions of VT and SVT, as well as diagnostic criteria including Brugada criteria, the lead aVR algorithm, and the RWPT (R wave to peak time) criterion. The document then analyzes ECGs of two case studies, concluding that the first is VT and the second is SVT with aberrant conduction based on application of the discussed criteria. It recognizes Prevost and Batelli for inventing defibrillation in 1899 by discovering electric shocks could
Bradyarrhythmias
Dr. Abraham discusses sinus node dysfunction and atrioventricular block. Key points include:
- The sinus node is usually located in the right atrium and receives blood supply from the right coronary artery or left circumflex artery.
- Symptoms of sinus node dysfunction range from asymptomatic ECG changes to tachycardia, bradycardia, and tachy-brady syndrome.
- Treatment options include pharmacotherapy with drugs like atropine or theophylline for short term use, and pacemaker implantation for long term treatment of sinus node disease.
- The atrioventricular node receives innervation from the arteries of Koch and shows minimal autonomic innervation. AV block can be first,
Ecg quiz @ SEMICON 1018
The presentation was given at SEMICON 2018 at MUMBAI on 16.03.2018 [ PG Refresher course in Emergency Medicine]
ECG: Trifascicular Block
A 73-year-old male presented with dizziness for 1 year and chest pain for 2 days. His ECG showed left bundle branch block (LBBB) and first-degree atrioventricular block, consistent with possible trifascicular block. Trifascicular block must be confirmed with bundle of His electrogram. The patient has abnormal conduction through one or more divisions of the intraventricular conduction system distal to the bundle of His, presenting as LBBB and first-degree AV block. This suggests involvement of the left and right bundles as well as the AV node, consistent with trifascicular block.
ECG: Pericarditis
A 58-year-old man presented with shortness of breath and chest pain. An ECG showed ST segment elevation consistent with pericarditis. Pericarditis is inflammation of the pericardium and can be caused by uremia in patients with chronic kidney disease. The ECG changes in acute pericarditis include diffuse concave ST elevation and upright T waves, except in leads aVR and V1 which are usually depressed. This differs from a myocardial infarction which shows more convex ST elevation and the presence of Q waves.
Assessment of shunt by cardiac catheterization
Cardiac catheterization is useful for assessing left-to-right shunts through three main techniques: oximetry runs to detect oxygen saturation step-ups, indicator dye dilution to detect early recirculation of dye injected into the proximal chamber, and angiocardiography to directly visualize the anatomic site of the shunt. While oximetry is best to localize the shunt, dye dilution can detect smaller shunts and angiography confirms anatomy. Together these techniques allow diagnosis and quantification of left-to-right intracardiac shunts.
Wide complex tachycardia
This document discusses wide complex tachycardias and how to differentiate them based on electrocardiogram (ECG) findings. It provides details on what makes a complex narrow or wide, types of wide complex tachycardias including ventricular tachycardia and supraventricular tachycardia, and ECG criteria to help determine the source and mechanism such as the presence or absence of RS complexes and their intervals. Morphologic criteria on the ECG and algorithms like the ACC algorithm are presented to aid in differential diagnosis.
Localization of WPW( accessory Pathway) by surface ECG
This document discusses localization of accessory pathways using electrocardiography. It describes that accessory pathways can be located in eight anatomical positions along the tricuspid and mitral valve annuli. Several algorithms are proposed to determine the location based on delta wave polarity and amplitude in various leads. The most accurate is the Arruda approach, which uses step-wise analysis of delta wave characteristics in leads I, II, aVL, aVF and V1 to identify the specific accessory pathway location with 90% sensitivity and 99% specificity. Characteristic ECG patterns are presented that help localize right anteroseptal, right posteroseptal, left lateral and right free wall accessory pathways.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Tachyarrhythmia
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
ECG: Atrial Bigeminy
The patient presented with an irregular pulse. An ECG showed evidence of two foci of atrial depolarization, indicating both right and left atrial premature depolarizations (APDs). The ECG pattern is known as atrioventricular bigeminy. The APDs are arising from a single irritable focus in the atria, which can be caused by various stimulants, toxins, or medical conditions. While usually benign, atrial bigeminy can potentially lead to more serious arrhythmias. Management involves correcting any underlying predisposing factors.
ECG: WPW Syndrome
A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
Tachyarrhythmias
This document discusses various tachyarrhythmias, including:
- Supraventricular tachycardias like atrial flutter, AV nodal reentrant tachycardia, and AV reentrant tachycardia.
- Ventricular arrhythmias including ventricular tachycardia and ventricular flutter.
- Irregular rhythms such as atrial fibrillation.
It provides details on characteristics like rate, morphology, underlying causes, and treatment approaches for each type of tachycardia. Emphasis is placed on distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy in clinical evaluation.
Emergency cadiac arrhythmias
This document discusses the management of various cardiac arrhythmias that present as emergencies, including tachyarrhythmias like ventricular tachycardia and fibrillation, as well as bradyarrhythmias. Algorithms are provided to guide clinicians in differentiating between ventricular tachycardia and supraventricular tachycardia based on electrocardiogram findings. Risk factors that increase the likelihood of ventricular tachycardia are outlined. Causes and management of other arrhythmias like atrial fibrillation, heart block, sinus bradycardia, and device malfunctions are also summarized. The goal is to aid clinicians in rapidly diagnosing serious arrhythmias and initiating the appropriate treatment in emergency settings
ECG/X-ray Quiz
This document contains an ECG report from the Department of Cardiology at JIPMER in Pondicherry, India. It describes the ECG findings of a patient who presented with narrow complex tachycardia and includes the results of an electrophysiological study and ablation. The EPS found the patient had atrial tachycardia originating from the left atrium posteriorly, and they underwent successful ablation. The document provides details of the case from initial ECG and symptoms to diagnosis and treatment.
Hypertrophic cardiomyopathy
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
ECG: Ventricular Premature Beats
1. The ECG shows a 45-year-old diabetic man with episodes of palpitations who presents with ventricular trigeminy.
2. Ventricular trigeminy is characterized by ventricular premature beats occurring after every two normal sinus beats with a compensatory pause.
3. Further investigation with Holter monitoring is recommended to better characterize the ventricular arrhythmia and assess for underlying cardiac disease.
ECG: Hyperkalemia
1. A 30-year-old male with fever and altered mental status was found to have a potassium level disturbance based on his ECG.
2. ECG changes due to electrolyte imbalances can vary between individuals and depend on other electrolyte levels as well.
3. However, certain consistent ECG features often indicate increased or decreased potassium, making ECG useful for identifying electrolyte issues if prior tracings are available for comparison.
AV Nodal Blocks
The document discusses the anatomy and physiology of the heart's conducting system. It describes the locations and functions of the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. It then explains different types of heart block including first-, second-, and third-degree heart block and their characteristics as seen on ECG. Treatment options are provided for the various heart block classifications.
Osborn wave venkat ppt
Osborn waves are positive deflections that occur at the junction between the QRS complex and the ST segment on electrocardiograms. They are usually observed in people with hypothermia below 32°C or with conditions like hypercalcemia, brain injury, or ventricular fibrillation. Osborn waves were first described in 1953 by Dr. John Osborn in his study of hypothermia in dogs and are named after him.
ECG: RBBB with LAFB
The ECG shows right bundle branch block (RBBB) and left anterior fascicular block (LAFB) in a 60-year-old hypertensive man. RBBB is characterized by a wide QRS complex with a terminal R wave in lead V1 and slurred S wave in lead V6. LAFB presents with left axis deviation and rS waves in lead III. The combination of RBBB and LAFB on an ECG suggests ischemia, as LAFB is commonly seen in acute anterior wall myocardial infarctions supplied by the left anterior descending artery.
ECG LIMB LEAD REVERSAL
1) Accidental misplacement of limb lead electrodes can cause ECG abnormalities that mimic pathology. Understanding Einthoven's triangle and how it relates the leads to electrodes is important for interpreting these abnormalities.
2) When the limb electrodes are swapped, Einthoven's triangle "flips" or "rotates" changing which leads invert, remain the same, or switch positions. Disrupting the triangle also distorts the central terminal altering all leads.
3) Specific electrode reversals cause predictable changes - LA/RA reversal inverts lead I; LA/LL reversal inverts lead III; bilateral arm-leg reversal makes lead I flat and leads II/III/aVF identical.
INTERESTING ECGS -- PART II
This document contains 16 medical cases involving electrocardiogram (ECG) readings and interpretations. Each case provides an ECG image and description of a patient's symptoms or medical history, and asks the reader to identify the diagnosis or next step. The document also includes explanations of various ECG patterns and conditions, such as R on T phenomenon, hyperkalemia, Brugada syndrome, lead reversals, and long QT interval with T-wave alternans. The goal is to teach readers how to properly analyze ECGs and apply that analysis to diagnosing cardiac conditions.
Clinical Cases In Cardiology
1) A 24-year-old man was diagnosed with Loeys–Dietz syndrome type 1 based on genetic analysis showing a mutation that puts him at high risk for aortic dissection.
2) A 59-year-old man with a history of carotid stenting presented with visual changes and was found to have retinal cholesterol emboli due to ongoing embolism after stenting.
3) An 83-year-old woman with atrial fibrillation and pacemaker presented with heart failure and was discharged on medical management.
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Ecg quiz @ SEMICON 1018
The presentation was given at SEMICON 2018 at MUMBAI on 16.03.2018 [ PG Refresher course in Emergency Medicine]
ECG: Trifascicular Block
A 73-year-old male presented with dizziness for 1 year and chest pain for 2 days. His ECG showed left bundle branch block (LBBB) and first-degree atrioventricular block, consistent with possible trifascicular block. Trifascicular block must be confirmed with bundle of His electrogram. The patient has abnormal conduction through one or more divisions of the intraventricular conduction system distal to the bundle of His, presenting as LBBB and first-degree AV block. This suggests involvement of the left and right bundles as well as the AV node, consistent with trifascicular block.
ECG: Pericarditis
A 58-year-old man presented with shortness of breath and chest pain. An ECG showed ST segment elevation consistent with pericarditis. Pericarditis is inflammation of the pericardium and can be caused by uremia in patients with chronic kidney disease. The ECG changes in acute pericarditis include diffuse concave ST elevation and upright T waves, except in leads aVR and V1 which are usually depressed. This differs from a myocardial infarction which shows more convex ST elevation and the presence of Q waves.
Assessment of shunt by cardiac catheterization
Cardiac catheterization is useful for assessing left-to-right shunts through three main techniques: oximetry runs to detect oxygen saturation step-ups, indicator dye dilution to detect early recirculation of dye injected into the proximal chamber, and angiocardiography to directly visualize the anatomic site of the shunt. While oximetry is best to localize the shunt, dye dilution can detect smaller shunts and angiography confirms anatomy. Together these techniques allow diagnosis and quantification of left-to-right intracardiac shunts.
Wide complex tachycardia
This document discusses wide complex tachycardias and how to differentiate them based on electrocardiogram (ECG) findings. It provides details on what makes a complex narrow or wide, types of wide complex tachycardias including ventricular tachycardia and supraventricular tachycardia, and ECG criteria to help determine the source and mechanism such as the presence or absence of RS complexes and their intervals. Morphologic criteria on the ECG and algorithms like the ACC algorithm are presented to aid in differential diagnosis.
Localization of WPW( accessory Pathway) by surface ECG
This document discusses localization of accessory pathways using electrocardiography. It describes that accessory pathways can be located in eight anatomical positions along the tricuspid and mitral valve annuli. Several algorithms are proposed to determine the location based on delta wave polarity and amplitude in various leads. The most accurate is the Arruda approach, which uses step-wise analysis of delta wave characteristics in leads I, II, aVL, aVF and V1 to identify the specific accessory pathway location with 90% sensitivity and 99% specificity. Characteristic ECG patterns are presented that help localize right anteroseptal, right posteroseptal, left lateral and right free wall accessory pathways.
Supraventricular tachycardias
This document discusses supraventricular tachycardias (SVT). It defines different types of SVT including paroxysmal SVT, which is common in emergency rooms. Quality of life is often poor for those with paroxysmal SVT. The document discusses mechanisms of SVT including reentry circuits, enhanced automaticity, and triggered activity. It provides details on differentiating AV nodal reentrant tachycardia from AV reentrant tachycardia using electrocardiogram findings. Treatment options discussed include carotid sinus massage, adenosine, and catheter ablation.
Tachyarrhythmia
This document provides an overview of evaluating and treating different types of tachycardia, including:
1) It discusses evaluating the patient's hemodynamic stability, history, and ECG to determine the characteristics and cause of the tachycardia.
2) It describes differentiating between narrow and wide complex tachycardias, and the differential diagnoses for each, including sinus tachycardia, atrial fibrillation, AV nodal reentrant tachycardia, and ventricular tachycardia.
3) It provides guidance on therapies for different tachycardias, such as electrical or chemical cardioversion, rate control, and ablation. The importance of correctly diagnosing wide complex tachycard
ECG: Atrial Bigeminy
The patient presented with an irregular pulse. An ECG showed evidence of two foci of atrial depolarization, indicating both right and left atrial premature depolarizations (APDs). The ECG pattern is known as atrioventricular bigeminy. The APDs are arising from a single irritable focus in the atria, which can be caused by various stimulants, toxins, or medical conditions. While usually benign, atrial bigeminy can potentially lead to more serious arrhythmias. Management involves correcting any underlying predisposing factors.
ECG: WPW Syndrome
A 45-year-old female presented with difficulty breathing, palpitations, and sweating for 4 hours. An ECG showed Wolff-Parkinson-White (WPW) syndrome, characterized by a short PR interval, delta wave, and widened QRS complex. WPW is a congenital condition involving an accessory pathway that allows supraventricular impulses to bypass the AV node and activate the ventricles early. Treatment options include antiarrhythmic drugs or radiofrequency ablation to destroy the accessory pathway.
Tachyarrhythmias
This document discusses various tachyarrhythmias, including:
- Supraventricular tachycardias like atrial flutter, AV nodal reentrant tachycardia, and AV reentrant tachycardia.
- Ventricular arrhythmias including ventricular tachycardia and ventricular flutter.
- Irregular rhythms such as atrial fibrillation.
It provides details on characteristics like rate, morphology, underlying causes, and treatment approaches for each type of tachycardia. Emphasis is placed on distinguishing ventricular tachycardia from supraventricular tachycardia with aberrancy in clinical evaluation.
Emergency cadiac arrhythmias
This document discusses the management of various cardiac arrhythmias that present as emergencies, including tachyarrhythmias like ventricular tachycardia and fibrillation, as well as bradyarrhythmias. Algorithms are provided to guide clinicians in differentiating between ventricular tachycardia and supraventricular tachycardia based on electrocardiogram findings. Risk factors that increase the likelihood of ventricular tachycardia are outlined. Causes and management of other arrhythmias like atrial fibrillation, heart block, sinus bradycardia, and device malfunctions are also summarized. The goal is to aid clinicians in rapidly diagnosing serious arrhythmias and initiating the appropriate treatment in emergency settings
ECG/X-ray Quiz
This document contains an ECG report from the Department of Cardiology at JIPMER in Pondicherry, India. It describes the ECG findings of a patient who presented with narrow complex tachycardia and includes the results of an electrophysiological study and ablation. The EPS found the patient had atrial tachycardia originating from the left atrium posteriorly, and they underwent successful ablation. The document provides details of the case from initial ECG and symptoms to diagnosis and treatment.
Hypertrophic cardiomyopathy
A 17-year-old male basketball player collapsed during practice and suffered cardiac arrest. An autopsy later revealed he had hypertrophic cardiomyopathy (HCM), a genetic heart condition where the heart muscle becomes abnormally thick. HCM is a leading cause of sudden cardiac death in young athletes. The patient had previously noticed some shortness of breath with exertion but it did not limit his activity. He was found to have a heart murmur as a child but it was never investigated. HCM causes the left ventricle to become thickened and stiff, which can obstruct blood flow out of the heart and cause heart failure, chest pain, arrhythmias, and sudden cardiac death.
ECG: Ventricular Premature Beats
1. The ECG shows a 45-year-old diabetic man with episodes of palpitations who presents with ventricular trigeminy.
2. Ventricular trigeminy is characterized by ventricular premature beats occurring after every two normal sinus beats with a compensatory pause.
3. Further investigation with Holter monitoring is recommended to better characterize the ventricular arrhythmia and assess for underlying cardiac disease.
ECG: Hyperkalemia
1. A 30-year-old male with fever and altered mental status was found to have a potassium level disturbance based on his ECG.
2. ECG changes due to electrolyte imbalances can vary between individuals and depend on other electrolyte levels as well.
3. However, certain consistent ECG features often indicate increased or decreased potassium, making ECG useful for identifying electrolyte issues if prior tracings are available for comparison.
AV Nodal Blocks
The document discusses the anatomy and physiology of the heart's conducting system. It describes the locations and functions of the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. It then explains different types of heart block including first-, second-, and third-degree heart block and their characteristics as seen on ECG. Treatment options are provided for the various heart block classifications.
Osborn wave venkat ppt
Osborn waves are positive deflections that occur at the junction between the QRS complex and the ST segment on electrocardiograms. They are usually observed in people with hypothermia below 32°C or with conditions like hypercalcemia, brain injury, or ventricular fibrillation. Osborn waves were first described in 1953 by Dr. John Osborn in his study of hypothermia in dogs and are named after him.
ECG: RBBB with LAFB
The ECG shows right bundle branch block (RBBB) and left anterior fascicular block (LAFB) in a 60-year-old hypertensive man. RBBB is characterized by a wide QRS complex with a terminal R wave in lead V1 and slurred S wave in lead V6. LAFB presents with left axis deviation and rS waves in lead III. The combination of RBBB and LAFB on an ECG suggests ischemia, as LAFB is commonly seen in acute anterior wall myocardial infarctions supplied by the left anterior descending artery.
ECG LIMB LEAD REVERSAL
1) Accidental misplacement of limb lead electrodes can cause ECG abnormalities that mimic pathology. Understanding Einthoven's triangle and how it relates the leads to electrodes is important for interpreting these abnormalities.
2) When the limb electrodes are swapped, Einthoven's triangle "flips" or "rotates" changing which leads invert, remain the same, or switch positions. Disrupting the triangle also distorts the central terminal altering all leads.
3) Specific electrode reversals cause predictable changes - LA/RA reversal inverts lead I; LA/LL reversal inverts lead III; bilateral arm-leg reversal makes lead I flat and leads II/III/aVF identical.
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Localization of WPW( accessory Pathway) by surface ECG
Localization of WPW( accessory Pathway) by surface ECG
Similar to Ecg quiz
INTERESTING ECGS -- PART II
This document contains 16 medical cases involving electrocardiogram (ECG) readings and interpretations. Each case provides an ECG image and description of a patient's symptoms or medical history, and asks the reader to identify the diagnosis or next step. The document also includes explanations of various ECG patterns and conditions, such as R on T phenomenon, hyperkalemia, Brugada syndrome, lead reversals, and long QT interval with T-wave alternans. The goal is to teach readers how to properly analyze ECGs and apply that analysis to diagnosing cardiac conditions.
Clinical Cases In Cardiology
1) A 24-year-old man was diagnosed with Loeys–Dietz syndrome type 1 based on genetic analysis showing a mutation that puts him at high risk for aortic dissection.
2) A 59-year-old man with a history of carotid stenting presented with visual changes and was found to have retinal cholesterol emboli due to ongoing embolism after stenting.
3) An 83-year-old woman with atrial fibrillation and pacemaker presented with heart failure and was discharged on medical management.
STEMI equivalents
1) The document presents 7 cases involving ECG patterns that can indicate acute coronary syndrome without ST elevation. Case 1 describes tall, symmetric T waves in the precordial leads indicating a possible left anterior descending artery occlusion. Case 2 shows biphasic T waves in leads V2-3 consistent with Wellens' syndrome. Case 3 demonstrates deeply inverted T waves in leads V2-3 also indicative of Wellens' syndrome.
2) Case 4 shows ECG changes in leads V1-3 consistent with a posterior myocardial infarction. Case 5 highlights ST elevation in lead aVR that can indicate a left main or proximal left anterior descending artery occlusion. Case 6 applies the Sgarbossa criteria to identify a possible infarction in
Clinical Cardiology
A 24-year-old man was hospitalized for evaluation of a dilated aorta and was diagnosed with Loeys-Dietz syndrome type 1 based on genetic analysis showing a mutation. An 83-year-old woman with atrial fibrillation and pacemaker presented with heart failure symptoms. Mortality rates after first hospitalization for heart failure are higher in men and increase with age.
Aortic dissection
This document presents the case of a 52-year-old male who presented with sudden onset severe back pain. Examination and tests revealed type B aortic dissection with possible acute kidney injury and polycystic kidney disease. The patient was managed medically but required endovascular intervention which was delayed, and he collapsed on the fourth day after referral. A review of literature discusses aortic dissection including causes, classification, clinical manifestations, physical findings, and management considerations.
Myocardial infarction
This document provides an overview of the definition and types of myocardial infarction (MI). It begins by defining ST-elevation MI (STEMI) according to guidelines. It then discusses the 5 types of MI: Type 1 spontaneous MI, Type 2 MI due to oxygen supply-demand imbalance, Type 3 sudden cardiac death, Type 4a PCI-related MI, and Type 4b stent thrombosis MI. It provides examples of ECG patterns associated with different coronary artery occlusions, including anterior wall MI, high lateral MI, inferior wall MI, right ventricular infarction, posterior wall MI, and left ventricular aneurysm. It asks questions to test recognition of these ECG patterns and diagnoses.
Myocardial infarction [autosaved]
This document provides an overview of the definition and types of myocardial infarction (MI) and discusses the coronary anatomy and ECG findings associated with different types of MIs. It defines the criteria for ST elevation MI (STEMI) according to American guidelines and introduces the 5 types of MI. It then discusses ST elevation MI and presents several ECG cases with questions about the diagnoses and culprit vessels. The document provides explanations of ECG findings that suggest conditions like left main coronary artery occlusion, left anterior descending artery occlusion, inferior wall MI, right ventricular infarction, posterior wall MI, and left ventricular aneurysm.
Kidney and vasculitis part 1 General approach and interactive cases
This document discusses vasculitis and provides a case study. It begins with an overview of vasculitis including what it is, which blood vessels can be affected, and classifications. It then presents a case of a 57-year-old male with renal dysfunction, anemia and hypertension. Tests showed p-ANCA positivity and a renal biopsy indicated RPGN. He developed endocarditis after steroid treatment. The diagnosis was determined to be infective endocarditis inducing vasculitis. Keys to differentiating secondary vasculitis from primary include double ANCA positivity, low complement levels, and multiple antibody positivities. The document concludes with recommendations when a patient has infection and is ANCA-positive.
11111801_Myocardial_infarction.ppt
This document provides an overview of myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle caused by a blockage of the coronary arteries that limits blood flow. The document discusses the epidemiology and symptoms of MI and outlines the criteria for diagnosis. It describes the role of laboratory tests like cardiac troponins and electrocardiograms in diagnosis. Early management includes oxygen, aspirin, nitroglycerin, and morphine for pain relief. Reperfusion strategies like percutaneous coronary intervention (PCI) or thrombolytics are discussed. Complications and classifications of MIs are also reviewed.
Wellens’ Syndrome: Exception to the Rule: One Referral at a Time!
We describe two patients with Wellens’ syndrome. In these patients, the electrocardiogram changes must be recognized promptly and accurately. These cases are managed aggressively and early invasive treatment approach is recommended to avoid myocardial infarction and death.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...
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Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.Rvmi.+ case
1. An 86-year-old female patient presented with chest pain, difficulty breathing, and general weakness. ECG results at the ambulance and hospital pointed to a diagnosis of posterior inferior myocardial infarction involving both the left and right ventricles.
2. She had multiple risk factors for heart disease including longstanding hypertension, diabetes, and atherosclerosis.
3. Intensive treatment in the ICU focused on fluid resuscitation, inotropes, and medications to stabilize her hemodynamics and support organ function as she presented with cardiogenic shock on admission.
Aortic dissection
Aortic dissection can can kill if not recognised and managed early. Chances of survival decreases by 10% per hour if left untreated.
ECGs in Acute Coronary Syndrome
A 52-year-old male presented with chest pain. His ECG showed evolving inferior wall myocardial infarction. ST depression is more frequently seen in lead aVL than other leads for inferior MI. A 51-year-old female presented with prior chest pain and is now pain-free. Her ECG shows Wellens' syndrome type I pattern and she should be monitored closely in the ICCU. Fragmented QRS complexes can indicate ischemia or scar tissue and are associated with worse cardiac outcomes.
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Inferior myocardial infarction
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Ekg Cases Jul09.Level One Part 1
Some additional potential causes of resting sinus tachycardia in an elderly person include:
- Heart failure
- Myocardial ischemia/infarction
- Pulmonary embolism
- Pneumonia/respiratory infection
- Anemia
- Medication effects (e.g. from diuretics)
- Electrolyte abnormalities like hypokalemia or hyperthyroidism
- Atrial fibrillation or other arrhythmias
Ekg Cases Jul09.Level One Part 1
Some additional potential causes of resting sinus tachycardia in an elderly person include:
- Heart failure
- Myocardial ischemia/infarction
- Pulmonary embolism
- Pneumonia/respiratory infection
- Anemia
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Ojchd.000550
This case report describes a 37-year-old man who presented with sudden onset severe left-sided neck pain and ST elevations on his ECG. He was incorrectly diagnosed with an anterior wall myocardial infarction and thrombolyzed. Further examination revealed differential blood pressures between his upper and lower extremities, suggesting an underlying aortic coarctation. Imaging confirmed severe coarctation of the aorta. The atypical presentation of neck pain and ECG changes were likely due to vasospasm and compression related to the coarctation. This case highlights the importance of a full clinical assessment prior to thrombolytic therapy to avoid unnecessary procedures.
Early management of ACS
Early Management of ACS - Presentation
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www.medicalgeek.com
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out of topics given - chose a topic and take the challenge
out of five question you should answer three- 3/5 (60%)- you should bet how much you want for each correct answer - 2 times, 3 times, 4 times, 5 times - 200 for each question - 3 times bet - 3 questions will be answered - if correct you get 600 - if wrong you lose half of the bet 300 - will you play?
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This document discusses heart rate, rhythm, and QRS axis. It describes how to calculate heart rate and defines different cardiac rhythms like sinus rhythm, atrial rhythm, and ventricular rhythm. It explains that the cardiac axis represents the sum of depolarization vectors and can be interpreted using the relationship between the QRS axis and limb leads on an ECG. Several methods for estimating the QRS axis are summarized, including using leads I and aVF, three lead analysis with leads I, II, and aVF, and the isoelectric lead method. Normal axis ranges are provided.
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The electrocardiogram, a basic tool in cardiology has been developed two centuries ago. It was recorded by a giant machine at that time, which is now being recorded on a mobile. Such is the advancement in ECG, which is still the gold standard in diagnosis of VT .
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Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
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Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
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Chapter 5
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Chapter 6
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Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
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4. BCP, Surveying volume 1
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Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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"Learn about all the ways Walmart supports nonprofit organizations.
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Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
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- 1. ECG QUIZ
- 2. Sir William Osler said, “Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease
- 4. What is the diagnosis Acute anterior wall MI later developed inferior wall MI ANTEROINFERO WALL MI PERICARDITIS FAILED THROMBOLYSIS a.Acute MI b.Inferoposterior with RVMI c.Pericarditis d. anterolateral MI who later developed inferior wall MI
- 5. Acute pericarditis with elevation of the ST segment in all leads, often up-sloping (red arrows), and PR depression in all leads (blue arrows), except for PR elevation in aVR (black arrow).
- 6. What is the diagnosis of the patient who present with acute chest <6 hrs Pain, not a k/c/o cad and there is trop t elevation ? a.Acute anterior wall MI b.Unstable angina c.Nstemid.none ©2009 by Cleveland Clinic
- 7. Poor R wave progression (red arrows) with terminally symmetric T waves in leads V1 through V6 (blue arrows), which suggests possible myocardial injury; this patient had positive troponin consistent with non-ST-elevation MI.
- 8. ST depression across the precordium (V1–V6) suggestive of subendocardial injury (black arrows). Where is the occlusion?
- 10. Where is the lesion? ©2009 by Cleveland Clinic
- 11. Inferolateral ST-elevation MI with ST elevation in II, III, and aVF (red arrows) indicating injury in the inferior wall in addition to ST elevation in V4 through V6 (blue arrows).
- 12. What is the complete Ecg diagnosis Categorise the vessel disease ©2009 by Cleveland Clinic
- 13. Anterolateral ST-elevation MI with ST elevation in V1 through V3 indicating infarction of the anteroseptal myocardium (red arrows), and in V4 through V6 and I and aVL indicating lateral wall involvement (blue arrows).
- 14. 5.which mimicks the STEMI more closely even in clinical features than the other ? A.pericarditis B.earlyrepolarisation variant C.taksotsubocardiomyopathy D.brugada syndrome
- 15. Answer : taksotsubocardiomyopathy The ECG findings are often confused with those found during an acute anterior wall myocardial infarction.Itclassically mimics ST-segment elevation myocardial infarction, and is characterised by acute onset of transient ventricular apical wall motion abnormalities (ballooning) accompanied by chest pain, dyspnea, ST-segment elevation, T-wave inversion or QT-interval prolongation on ECG. Elevation of myocardial enzymes is moderate at worst and there is absence of significant coronary artery disease.[1]
- 16. 6.This 74 yo male had just returned to his unit bed after successful PTCA of tight lesions of the first diagonal and obtuse marginal coronaries. He complained of chest pain. This ECG was recorded. The previous is below.
- 19. 6.WHAT IS THE DIAGNOSIS?
- 20. 7.a patient had renal failure .creatinine clearance is 60ml/min ..what should the patient receive post thrombolysis? A.UFH only B.LMWH same doses C.LMWH reduced dose.
- 21. B.LMWH same dose Only when creatinine clearance is less than 30 ml/min the dose to be reduced. Ncbl.nim.com
- 22. 8.which is most fibrin specific ..and what is its advantage? A.tenectplase B.reteplase C.alteplase D.streptokinase
- 23. Ans –tenectplase Single bolus More fibrin specific
- 24. 9.a patient developed bradycardia on monitoring..ecg diagnosis was made..which is more at risk of going into CHB and who to be sent for pacemaker? A.anterior wall MI with mobitz type 1 block B.Anterior wall MI with mobitz type 2 block C,.Inferior wall MI with mobitz type 2 block D.Inferior wall MI with unresponse to atropine
- 25. Anterior wall MI with mobitz type 2 block..
- 26. 10 .which papillary muscle is damaged in anterior wall MI and inferior wall MI ? WHY so ?
- 27. Anterolateral in anterior wall mi Posteromedial in inferior wall MI
- 28. THANK YOU