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ECG Abnormalities_Part 08

Wednesday, October 13, 2010

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:

What is the abnormality in this ECG strip?


The ECG findings include:
1) Normal sinus rhythm
2) Marked T wave inversions and prolonged QT interval

Answer: A CT scan of the brain is needed. His clinical picture and ECG findings are consistent with an acute central nervous system abnormality. Patients with subarachnoid hemorrhages, intracranial hemorrhages, and less commonly severe ischemic strokes have ECGs that reveal deep, symmetric T wave inversions and QT prolongation. Less commonly, carotid endarterectomy can result in this ECG pattern chronically.


22 Responses to ECG Abnormalities_Part 08

  1. ECG Differentials
    left ventricular strain
    or Acute coronary syndrome

  2. Subarachnoid hemorrhage is consistent with these ECG abnormalities, and unresponsiveness with heart/respiratory rate alterations strongly suggest increased intracranial pressure.

  3. Anonymous Says:
  4. extensive IHD

  5. Anonymous Says:
  6. coronary artery disease

  7. Heartbit Says:
  8. endocranial expansive process can be postulated... hemorrhagic nature agrees with patient's history

  9. Anonymous Says:
  10. this ecg is normal in HR (75 bpm), PR and QRS duration and morphology, axis. T waves are inverted in every derivation but V1 and V2.

  11. Anonymous Says:
  12. If serial cardiac enzymes and tropenine remain negative ,do CT scan brain to role out strok,

  13. Ιωσήφ Says:
  14. Subendocardium infarct or acute coronary episode

  15. Anonymous Says:
  16. accelerated idio ventricular rythem

  17. Anonymous Says:
  18. myocardial ischemia

  19. Anonymous Says:
  20. onde P present et QRS etroit onde T inverted espace P qrs regulier et normale en plus rythme regulier ENZYME CARDIQUE??????
    DIG LEVEL ??????
    ensuite si normale on cause cerebrale hemorragique.....

  21. Anonymous Says:
  22. ischemia in leads V4 V5 V6 II nd avf..

  23. Anonymous Says:
  24. Lt ventricular strain pattern evident in all leads ESP V4,5,6
    Hypertension and Brady consistent with Intracerebral Hge (Cushing effect)

  25. Anonymous Says:
  26. Heart rate is normal, then how can u say that there is bradycardia?

  27. Anonymous Says:
  28. He got Sd.Cushing effect!

  29. Anonymous Says:
  30. ischemic pattern changes in anterior, inferior and lateral wall leads

  31. Anonymous Says:
  32. differential diagnosis= sub endocardium mi, cerebrovascular stroke, HCM

  33. Anonymous Says:
  34. subarachnoid hemorrhage

  35. ACS

  36. Anonymous Says:
  37. Classic Cushings Triad - Widening pulse pressure with increase in SBP.
    I bet the pupils are unequal or nonreactive
    Surprised that the patient does not have
    increased Kussmals respirations

    The patient does have severe increased intercranial pressure which is evident witht he deep TW inversions on the EKG.....Activate Neuro can do a CT after to verify.

  38. dr Nasr Says:
  39. Atrial flutter

  40. Anonymous Says:
  41. I'd say, this is probably a case of Long QT of whom I suffer myself.


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