Professional Documents
Culture Documents
Introduction
A Basic tool
So readily available
Cheap but so informative
If you make the right decision and
recognize the pattern/pathology
accurately it will SAVE a LIFE
MISS RATE ?
Case 1
24 year old lady, Post LSCS D 26 for breech
Presents with lightheadedness, new onset
seizures/LOC 1 week, extension of both UL and LL,
uprolling of eyes.
Blood pressure 116/84 mmHg. Taking Gamat
Questions
What is the diagnosis
What are the causes of
Seizures/syncope in a young patient
Corrected QT interval
The Bazett formula is the formula most
commonly used to calculate the QTc, as
follows: QTc = QT/square root of the R-R
interval (in seconds).
QT interval corrected for heart rate (QTc)
that is longer than 0.44 seconds is
generally considered to be abnormal,
although a normal QTc can be more
prolonged in females (up to 0.46sec).
Progress
Refered to Cardiology same day
Diagnosis: Long QT syndrome
AICD inserted
Propranolol 40 mg bd.
Case 2
70 year old man, brought to hospital with c/o
palpitation and giddiness, long standing DM,
Hypertension and gout. Blood pressure
110/66mmHg
In the ward patient has an ECG done
HR
100/m
Decisions
History
No chest pain
No traditional medications
Did you take a lot of bananas - NO NO,
NOOO
Not on any K supplements
Not on ACE inhibitors
Furthur information
K 8.8mmol/l
Patients son said father has Advanced
Renal Failure
Son confesses patient had a durian feast
last 2 days
P-wave flattening,
PR-interval,
QRS prolongation,
ST elevation
High-grade AV blocks,
Intraventricular conduction abnormalities
(including fascicular blocks and bundle
branch blocks), and
Finally a sine-wave appear- ance on the
rhythm.
K
7.5mmol/l
K 6.8mmol/l
Hyperkalemia
Remember
Hyperkalemia is a Na channel poison
Amiodarone, lignocaine, procainamide
are Na channel blockers
Pointers
Hyperkalemia can mimic VTach
Suspect when QRS is very wide or when
rate is too slow for VT
Pointers
Case 3
29 year old gentleman.
Presents with palpitation, Blood pressure is
108/74mmHg
WPW with AF
Irregular WCT
Electrical Cardioversion
Case 4
84 year old man who presented with chest pain,
he was given thrombolytics earlier in the
morning , now is pain free. BP 116/78mmHg, HR
110/m You come in as the in charge senior MO to
CCU in the morning
Rate 110/m
What
is this
ryth
m
Ventricular rhythm
Ventricular rate 20-40 ventricular
escape rhythm (Idioventricular rhythm)
Ventricular rate 60-120 (accelerated
idioventricular rhythm) AIVR
Ventricular rate >120 Ventricular
tachycardia (130-250)
Caveat
Remember
Other mimics of Ventricular
tachycardia(rate < 120)
Hyperkalemia
Sodium channel blocker toxicity
Accelerated Idioventricular
rhythm (AIVR)
Sometimes called slow VT
Suggests successful reperfusion of an
occluded coronary artery in AMI. Cause?
Other presentation digoxin toxicity,
post cardiac arrest rhythm, severe
electrolyte abnormalities
Accelerated Idioventricular
rhythm (AIVR)
Usually transient
Unlikely to cause hemodynamic
instability
Supression can lead to instability and
asystole
Treatment: Observe!
Case 5
47 year old man presents with atypical chest pain,
BP 80/50 mmHg, tachypneic
Diagnosis?
Story goes
Diagnosed Inferior lateral MI
Given Loading Aspirin 300mg,
Clopidogrel 300mg, Fondaparinux 2.5
mg and Thrombolysed with Metylase
Shortly after patient collapsed and could
not be revived
Small complexes
Saddleback ST
elevation
Depressed
PR seg
Electrical alternans
Low Blood
Pressure
Diagnosis
Case 6
29 year old man
Found unconscious
Presumed intoxicated
Questions
Intoxicated patient
Found unconscious
ARE the ECG changes territorial?
Subarachnoid
hemorrage
Goldstein DS et al
Case 7
A 57-year-old woman, with a history of
hypertension, was admitted to the CCU due to an
atypical, non-compressing, excruciating chest
pain of recent origin (30 minutes) with radiation
to the back.
Case presentation
What is
your
diagnosis?
Case 1
78 year old Man
DM, HTN
Presents with presyncopal attack
Also has chest pain 4/10 the same day,
no autonomic symptoms,
Pain score reduced to 1/10 with GTN
ECG
Progress
Diagnosis Inferior Myocardial Infarction
Metylyse 60,000 u given
2 hours later patient complaints of
headache, vomited
DAPT not continued and LMWH not
started.
Urgent CT brain ordered
Case 2
40 year old male
Homeless
Hypertensive but defaulted treatment
Body weakness for 7 days
Shortness of breath 1 day
Clinical
Blood pressure193/139mmHg
Lungs; Crepitations bibasal to mid
Troponin T 0.3
ECG ST elevation V1-4
Started on IVI GTN
BP reduced to 180/110 mmHg
Progress
90 minutes later patient vomited few
times
GCS dropped 3 hours later
Urgent CT brain
Creatinine 182umol/l
Progress
Pericarditis
Benign early repolarization
Left bundle branch block
Left ventricular hypertrophy
Ventricular aneurysm
Brugada syndrome
Ventricular paced rhythm
Raised intracranial pressure
Conclusion
Consider Clinical scenario
Take a good history
Dont rush unless it is hemodynamically
unstable
Conclusion
Just because Electrocardiography is a
basic skill it doesnt mean our skills
should be basic
A ton we have not learnt about ecgs
Every day we learn something new
YOU must strive be the experts in
Electrocardiography
Saves lives
REMEMBER
END
THANKS
ECG
What is the
diagnosis?
ECG