ECG Cases

This ECG registered in patient without pulse shows pulseless electrical activity. Pulseless electrical activity (Electromechanical dissociation) is one of three types of cardiac arrest together with ventricular fibrillation and asystoly. Normally electrical activity produces mechanical activity. In electromechanical dissociation we have electrical activity in ECG but no pulse is present. This pathology should be treated with cardiopulmonary resuscitation. In ECG, electromechanical dissociation may have different appearance (with narrow or wide QRS complexes).

A)     Polymorphic ventricular tachycardia. We can see wide complex tachycardia with QRS complexes that have different amplitude, axis and continuously evolving morphology. B)      Atrial Fibrilation. Irregularly irregular rhythm with no P wave. C)     Atrial flutter with 2:1 conduction D)      Low atrial rhythm. Inverted P wave before each QRS complex and constant PR interval.

This ECG shows: a) RBBB b) LBBB c) IVCD This ECG present typical changes for RBBB. The RBBB criteria fulfilled in this case are: -           Supraventricular rhythm. -           Wide QRS complex (>120 ms) with rsR’ morphology. -           Slurred S wave in V6. -           T wave discordance in precordial leads.   The most common cause of RBBB are: ASD, COPD, right ventricular hypertrophy, pulmonary thromboemboli, ischaemic heart disease, hypertension, cardiomyopathy.

What is your diagnosis?               a)         STEMI inferioris + second degree AVB              b)       Normal sinus rhythm + STEMI inferioris              c)       Normal ECG              d)    STEMI inferioris + NSTEMI parietis lateralis

The most probable diagnosis on those rhythm strips are as following: a) Sinus rhythm with wide QRS complexes. b) Atrial fibrilation with wide QRS complexes. c) PSVT (paroxysmal supraventricular tachycardia). d) WCT (most probable Ventricular tachycardia). e) Escape junctional rhythm

Patient with chest pain. What is your diagnosis? a)       STEMI infero-posterioris. Mobitz I b)       STEMI infero-lateralis. Mobitz I c)        STEMI inferioris. Mobitz II d)       STEMI inferioris. Total AVB e)       STEMI inferioris. NSTEMI anterioris. Second degree AVB This ECG shows ST elevation in inferior leads that’s mean STEMI inferior is present.   Posterior STEMI is suggested by horizontal ST depressions, upright T Wave and tall R wave in right precordial leads. PR interval is not constant. We can see progressive prolongation of this interval culminating with non conducted P wave, typical for second degree AVB, Mobitz I, that appear in P:QRS group with ratio 3:2 or 4:3. Incomplete LBBB is present too. Final diagnosis: a)  STEMI infero-posterioris. Mobitz I