MediCases

A 21 year old healthy female comes to the clinic with complaints of intermittent palpitations. These episodes can last from seconds to minutes and are associated with lightheadedness, diaphoresis, and occassionally chest pain. Her ECG is below:

What is the Abnormality in ECG 1?

An 87 year old male with a history of coronary artery disease has the below ECG:

ECG ANSWER

A 58 year old male with a history of  DM, hypertension, and dyslipidemia presents with substernal chest pressure for 30 minutes. The pain began at rest,severe in nature, was mild to begin with then increased in intensity, is worse with exertion, radiates to his left arm, is not pleuritic or positional, and is associated with diaphoresis, shortness of breath, and nausea.
His temperature is 37.2, blood pressure 90/50mmhg, heart rate 100/bpm, respiratory rate is 16/min. No jugular venous distension is present, he is tachycardic and an S4 heart sound is present. No murmurs are heard. His lungs are clear to auscultation. The rest of his exam is normal.

ECG ANSWER

A 72 year old male receives a routine ECG which is below. His electrolytes are normal.

ECG ANSWER

An 82 year old male with a history of hypertension presents to the clinic with a complaint of generalized weakness for 3 days. No chest pain, shortness of breath, dyspnea on exertion, lower extremity edema, paroxysmal nocturnal dyspnea, orthopnea, palpitations, or dizziness. He takes lisinopril and hydrochlorothiazide for his hypertension.

His temperature is 37.0, blood pressure 100/50 mmHg, heart rate 155 bpm, respiratory rate is 16/min. No jugular venous distension is present, he is tachycardic and irregularly irregular on cardiac exam without any murmurs. His lungs are clear to auscultation. The rest of his exam is normal.

His ECG is below

ECG ANSWER

A 68 year old male with a past history of chronic atrial fibrillation presents to the emergency room with a complaint of nausea, vomiting, generalized abdominal pain, and generalized weakness. No fevers or chills. No diarrhea, constipation, melena, or other signs of gastrointestinal bleeding. He does not know his medications. He states his vision has been slightly yellow tinged recently.

His temperature is 37.0, blood pressure 90/50, heart rate 55, respiratory rate is 16. No jugular venous distension is present, he is bradycardic and irregularly irregular on cardiac exam without any murmurs. His lungs are clear to auscultation. His abdominal exam is completely normal. The rest of his exam is normal.

His ECG is below:

ECG ANSWER

ECG ANSWER

A 86 year old male with no significant past medical history to clinic with a complaint of generlized weakness, dizziness, and dyspnea on exertion. Mild lower extremity edema, paroxysmal nocturnal dyspnea, and orthopnea are present. No chest pain has occured. He is not taking any medications.

His temperature is 37.0, blood pressure 80/40mmHg, heart rate 40/BPM, respiratory rate is 16/min. Mild jugular venous distension is present, he is bradycardic and regular without any murmurs. His lungs are clear to auscultation. The rest of his exam is normal.

His ECG is below:

ECG ANSWER

A 50 year old male with no past medical history presents to the emergency room with sudden onset severe chest pain. The pain is 10/10, substernal, sharp in nature, worse with deep inspiration, not positional or reproducible, and associated with shortness of breath and dizziness but no excessive sweating , nausea, or vomiting.

His temperature is 37.0, blood pressure 80/40, heart rate 110, respiratory rate is 28. His oxygen saturation is 88% on room air. He appears in mild distress, no jugular venous distension is present, he is tachycardic and regular without any murmurs. His lungs are clear to auscultation. The rest of his exam is normal.

His ECG is given below:

ECG ANSWER

A 53 year old male with a history of uncontrolled hypertension is found unresponsive at the side of the street and is brought to the emergency room.

His temperature is 37.0, blood pressure 190/100, heart rate 50, respiratory rate is 8. He is unrepsonsive on physical exam. Heart and lung exams are normal. Laboratory studies including electrolytes and troponin levels are all normal.

His ECG is below:

ECG ANSWER

A 27 year old female with a history of HIV infection presents to the emergency room with a complaint of increased dyspnea on exertion and lower extremity edema over the past 6 months. She denies chest pain, paroxysmal nocturnal dyspnea or orthopnea.

Her temperature is 37.0, blood pressure 90/50, heart rate 110, respiratory rate 20. She has large V waves in her jugular venous pulsations, a III/VI pansystolic murmur at the left lower sternal border which gets louder with inspiration, and a right ventricular S4 heart sound is heard. A pulsatile liver is palpated.

Her ECG and chest x-ray are given below:

ECG ANSWER

Chest XRAY ANSWER

A 23 year old female  medical student presents to the emergency room with altered mental status. Her friends say she has been drinking hard liquor non-stop for 1 week after her final exams and has not been eating well for months. She was recently started on erythromycin for a upper respiratory tract infection.
Her temperature is 37.0, blood pressure 90/50, heart rate 70, respiratory rate 10. She is thin and cachectic appearing. She is arousable but unable to answer questions or follow commands. Her heart and lung exam are normal.
Her laboratory studies reveal a potassium level of 2.1 (normal 3.5-5.0), a magnesium level of 0.9 (normal 1.8-3.0), and a calcium level of 5.0 (normal 9.0-10.5). Her ECG is below:

ECG 01 ANSWER

ECG 02 ANSWER