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ECG Abnormalities_Part 16

Friday, November 26, 2010

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

What is the Abnormality?

ECG ANSWER

The ECG findings include:

1) Normal sinus rhythm with first degree AV block
2) Right bundle branch block (RBBB)
3) Left anterior fascicular block (LAFB or left anterior hemiblock or LAHB)
4) PVC

ECG Abnormalities_Part 15

Sunday, November 21, 2010

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.


What is the diagnosis?

ECG ANSWER

The ECG findings include:

1) Normal sinus rhythm
2) Poor R wave progression (possibly indicated an anterior wall infarct - age undetermined)
3) Old inferior wall infarct (indicated by Q waves in inferior leads)
4) Biphasic T waves in leads V1 - V4 possibly consistent with ischemia

ECG Abnormalities_Part 14

Wednesday, November 17, 2010

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

Identify the Abnormality in this ECG strip?

ECG ANSWER

Normal sinus rhythm with a first degree AV block

The PR interval in this ECG is very long, about 380 milliseconds (normal is 120 - 200 ms or 0.12 - 0.20 seconds). A P wave preceeds each QRS complex, thus this is 1st degree AV nodal block.

ECG Abnormalities_Part 13

Saturday, November 13, 2010

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

What Is the Abnormality in this ECG?

ECG ANSWER


The ECG findings include:

1) Atrial fibrillation with rapid ventricular response
2) PVC(Premature ventricular contraction)

Atrial fibrillation occurs when the atrial conduction becomes chaotic and very fast. The atrial rate increases to around 400-600 beats per minute. When this occurs, the amplitude of the P waves markedly decrease. Frequently, the P waves are not able to be detected at all, however at times a coarseness of the baseline of the ECG occurs reflecting the fibrillatory atrial activity. Not all of the 400-600 atrial action potentials per minute are conducted to the ventricles otherwise ventricular fibrillation would occur. Instead, the AV node is able to block a good number of beats usually resulting in a ventricular rate between 120-180 in the absence of AV blocking medications. Due to the chaotic atrial activity, varying block of the atrial action potentials at the AV node occurs resulting in an irregularly irregular rhythm.

ECG Abnormalities_Part 12

Sunday, November 7, 2010

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:

 Identify the Abnormality?

ECG ANSWER

The ECG findings include:

1) atrial fibrillation with bradycardia
2) ST segment depression consistent with digoxin effect

The ECG shows a downsloaping ST segment depression in multiple leads that are shaped like the "reverse check mark sign" or a "scooped out" appearance. This pattern is typical of digoxin. This may occur at normal digoxin levels in some people, but becomes more common as the digoxin level increases.

ECG Abnormalities_Part 11

Friday, November 5, 2010

A 38 year old female presents to the emergency department with a complaint of palpitations for 2 hours. She complains that she has intermittently had palpitations for years, but always lasting for minutes only. These palpitations are associated with mild dizziness and shortness of breath. No chest pain occurs.

Her temperature is 37.0, blood pressure 90/50, heart rate 190, respiratory rate is 16. No jugular venous distension is present, she is tachycardic and regular on cardiac exam without any murmurs. Her lungs are clear to auscultation. The rest of her exam is normal.
Identify this ECG rhythm?


ECG ANSWER

The ECG findings include:

Narrow complex tachycardia - most likely AV nodal rentry tachycardiaa (AVNRT)

The ECG shows a narrow-complex tachycardia that is regular.No flutter waves are seen. In leads V3 - V6 a P wave can be seen just after the QRS complex making this rhythm a "short-PR" tachycardia. Remember the most common short-PR tachycardia is AV nodal rentry tachycardia.

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