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.

1. SPOTTERS
(ECG,CXR,ECHO)
DR. MAHENDRA
CARDIOLOGY,JIPMER

2. 1.A 75 year old man with a history of COPD presents with fever and increased
sputum production. An ECG is taken in the emergency department. What does it
show?

3. • Diagnosis: polymorphic atrial tachycardia
• Ecg feature-
• Heart rate > 100 bpm (usually 100-150 bpm; may be as high as 250 bpm).
• Irregularly irregular rhythm with varying PP, PR and RR intervals.
• At least 3 distinct P-wave morphologies in the same lead.
• Isoelectric baseline between P-waves (i.e. no flutter waves).
• Absence of a single dominant atrial pacemaker (i.e. not just sinus rhythm with frequent
PACs).
• Some P waves may be nonconducted
• others may be aberrantly conducted to the ventricles.

4. 2.68 yr old female with old MI, c/o palpitation ,giddiness
ecg show??

5. • Irregularly irregular rhythm
• Rate approx. 200/min
• Initially narrow complex change into wide complex tachycardia with changing
axis.
• p/o
• AF with aberrancy
• Preexcited AF
• VT

6. 3.Presented with palpitation

7. After adenosine

8. • Regular narrow complex tachycardia
• Short RP
• Rate 150/min, normal axis
• Pseudo s and r present
• Respond with adenosine
• p/o AVNRT

9. 4.18 year old man signs up to join the army. He is fit and well. This is his ECG taken at
his medical examination. Is it normal

10. • ECG is characteristic of Brugada Syndrome (Type 1)
•

12. 5.Diagnosis??

13. • R on T phenomenon:
• sinus rhythm with frequent PVCs in a pattern of ventricular bigeminy.
• QT interval is markedly prolonged (at least 600ms), with each PVC falling on the
preceding T wave (= ‘R on T’ phenomenon).
• ECG is extremely high risk for TdP

14. 6.diagnosis??

15. • HYPOKALEMIA
• Typical U wave seen
• Camel hump sign
• Prolonged repolarisation

16. 7.Diagnosis ??

17. • Exercise stress test in a patient with CPVT.
• Progressively worsening ventricular arrhythmias are observed during exercise.
• Typical bidirectional VT develops after 1 minute of exercise
• Arrhythmias rapidly recede during recovery.

18. 8.

19. Atrial lead dislodgment to ventricle

21. 9.c/o recurrent palpitation diagnosis?

22. Typical atrial flutter

23. 10.Pressure tracing
interpretation ??

25. 11.6 yr old child with cyanosis
left side LV/RV tracing, rt side PA tracing

26. • RV and Ao pressures are equal
• PA pressures –Normal
• Diagnosis
• VSD,PS physiology

27. 12.60 yr old male with cardiogenic shock
xray taken after cardiac intervention

28. 28
- The end of the balloon should be just distal (1-2 cm) to the takeoff of the
left subclavian artery
- Position should be confirmed by fluoroscopy or chest x-ray
iabp ballon positioning

29. THANK YOU