This document contains summaries of ECG findings for various patients. Key cases include: - A 95-year-old patient with faintness and a systolic murmur, whose ECG and murmur were suggestive of critical aortic stenosis. - A 13-year-old with sudden palpitations found to have sinus tachycardia from rheumatic fever. - A 10-year-old Māori boy with joint pain and swelling found to have myocarditis from acute rheumatic fever, shown on his ECG. - A 35-year-old with chest pain and palpitations found to have Wolff-Parkinson-White syndrome. The document

1. Random ECGs 1
Dr Chris Cresswell
Emergency Physician
2015

2. 95 F with 10 minutes of faintness and a systolic
murmur

3. 95 F with 10 minutes of faintness and a systolic
murmur
R wave in aVL > 11mm is one criterion for LVH
This ECG + murmur suggestive of critical aortic stenosis
= does not go home

4. 13 year old with sudden onset of palpitation while
playing X-Box

5. 13 year old with sudden onset of palpitation while
playing X-Box
Was thought to be an SVT
But p wave in V1
And HR variable on monitor
Sinus rhythm -> look for the cause
Turned out to be sinus tachy from rheumatic fever

6. 13 year old female presenting with agitation after taking “party pills”

7. 13 year old female presenting with agitation after taking “party pills”
This patient was admitted overnight due to an
abnormal ECG
This is a normal paediatric ECG

8. Common findings on a paediatric ECG
Heart rate >100 beats/min
Rightward QRS axis > +90°
T wave inversions in V1-3 (“juvenile T-wave pattern”)
Dominant R wave in V1
RSR’ pattern in V1
Marked sinus arrhythmia
Short PR interval (< 120ms) and QRS duration (<80ms)
Slightly peaked P waves (< 3mm in height is normal if ≤ 6
months)
Slightly long QTc (≤ 490ms in infants ≤ 6 months)
Q waves in the inferior and left precordial leads.

9. 70 year old with palpitation and chest pain

10. Atrial flutter
• Clues
– Rate around 150
– Saw tooth base line or double p waves
• Manage as for AF
– Search and treat cause
– If no cause or compromised
• Cardiovert if < 48 hours otherwise rate control eg dilitazem

11. 35 year with recurrent chest pain and
palpitations

12. 35 year with recurrent chest pain and
palpitations
Delta wave and short PR interval
Wolff Parkinson White Syndrome
If regular SVT won’t be able to tell it’s WPW from ECG
treat as normal for SVT
Vagal maneuvers then eg diltiazem
If irregular wide complex tachy -> electricity

13. 10 year old Māori boy with sore ankles
and knees and lower leg oedema

14. 10 year old Māori boy with sore ankles
and knees and lower leg oedema
1st
degree heart block (+ prolonged QTc)
In this context suggestive of myocarditis from
acute rheumatic fever

15. 75 M with chest pain

16. 75 M with chest pain
Atrial flutter with variable block
Treat as for AF
In this context
no rate control needed
old or new
? Needs anticoagulation

17. 39 F alcoholic ?overdose

18. 39 F alcoholic ?overdose
Flat Ts
U waves
Hypokalaemia: K 3.3

19. 75 M with COPD

20. MFAT
Irregularly irregular but a p wave before each QRS
P waves are different sizes and shapes
P waves are coming from multiple foci in the atria
= Multifocal atrial tachycardia
Seen in COPD
Stage before AF

21. 70 year old SOB

22. Atrial flutter
With variable block
Saw tooth baseline

23. 74 female, cough, SOB, 1/12 post
THJR

24. PE
Signs of right heart strain
Tachycardia
R axis deviation (not seen in this ECG)
Inferior and anterior T wave inversion
R in V1
(S1 Q3 T3 is neither sensitive or specific enough to be useful)

25. 25 year old first seizure

26. Prolonged QT - congenital

27. 72 year old with pneumonia and
mild anaphylaxis to diclofenac

28. Mobitz II

29. 86 year old epigastric pain and SOB

30. Mobitz II again. On beta blockers

31. 35 M with CP

32. Pericarditis
PR depression II, V2-V6
PR elevation aVR
Saddle shaped ST elevation V4 and V5