ECG Cases

Patient with dyspnea.? QRS complexes are narrow with low amplitude. Maximal amplitude of QRS complex in the limb leads is 2mm and in precordial leads 8mm. Low voltage ECG is confirmed if QRS amplitude in limp leads is less then 5mm and in precordial leads less then 10mm. The most common cause of microvoltage are: Pericardial effusion, COOD, obesity, hypothyroism, restrictive cardiomyopathy. Next significant findings is irregularly irregular rhythm without P wave. This is enough to diagnose atrial fibrillation with ventricular rate ~90/min. Final diagnosis: Microvoltage. Atrial fibrilation with controlled ventricular rate.

A) Sinus tachycardia is sinus rhythm with heart rate over 100/min. This rhythm is regular with normal appearance P wave and normal duration PR intervals. QRS complexes can be narrow or wide. B) Sinus bradycardia is sinus rhythm with heart rate bellow 60/min. This rhythm is regular with normal appearance P wave and normal duration PR intervals. QRS complexes can be narrow or wide. C) Sinus arrhythmia is sinus rhythm with variation of P-P (R-R) intervals at least 120ms. P wave has normal appearance and normal PR intervals. QRS complexes can be narrow or wide.

Choice two right answers about this ECG? Inferior STEMI+ Lateral NSTEMI  Inferior STEMI LCX is Culprit artery  RCA is Culprit artery  LAD is Culprit artery.    ST elevation in leads II, III and aVF with Q waves in II, aVF plus reciprocal ST depressions in aVL diagnose STEMI parietis inferioris. ST depression in lateral leads doesn’t present NSTEMI. If ST elevation in lead III > lead II than RCA is culprit artery. Circumflex occlusion in inferior STEMI is suggested if ST elevation in II = ST elevation in III with absence of reciprocal ST depression in lead I.

Name this Blocks A. First degree AVB is present in this rhythm strip. Every P wave is conducted, but with prolonged PR interval (~320ms). B. Second degree AVB type 1 (Mobitz I) is present in this rhythm strip. We can see progressive prolongation of the PR interval culminating in a non-conducted P wave (3d and 7d P wave are non-conducted). C. Second degree AVB type 2:1 is present in this rhythm strip. We can see that there are 2P waves for every QRS complex. We don’t have two P wave conducted in a row so can’t conclude if PR interval is prolonged (Mobitz I) or constant (Mobitz II). D. High degree AVB (3:1) is present in this rhythm strip. We can see that just every 3d P wave is conducted (with constant PR interval) and two out of every three P wave are blocked. E. High degree AVB (4:1) is present in this rhythm strip. We can see that just every 4d P wave is conducted (with constant PR interval) and three out of every four wave are blocked. F. Third degree AVB is present i

1. The first ECG finding of this ECG Case is non standard voltage calibration . Instead of 10mm/1mv, voltage calibration is done 5mm/1mv. Half standard calibration was used to prevent superposition of waveforms.             At the beginning of the ECG recording, the ECG machine automatically performs a calibration while recording a rectangular shape signal with different amplitude. Fig.1.The calibration signal (marked with red) has 5mm vertically. This show presence of half standard calibration (5mm/1mv), instead of 10mm/mV. 2. Basic normocardic sinus rhythm is interfered from a Ventricular Extrasystole (QRS nr. 4). This complex fulfills all criteria for Ventricular Extrasystole: QRS is wider than 0.12 s, is premature, followed by a compensatory pause and discordant ST.               From QTS complex nr.7, begins a regular uniform wide complex tachycardia and continues until end of rhythm strips (QRS nr.24). Rhyt

  20 years old male patient with episodes of dizziness. In this patient with sinus rhythm, clearly there are some blocks on this ECG.              1.        Right bundle branch block (RBBB), as was marked with red color.                  - QRS duration >120 ms                  - QRS with morphology rsR’ in lead V1 and slurred S wave in V6.                   -Discordant T wave in V1.         2.      Left anterior fascicular block (LAFB), as was marked with blue color.                   - Left axis deviation, >-30                   - qR in leads I and aVL and rS complexes in leads II and III                3.     First-degree atrioventricular block, as was marked with red color.                    - PR interval duration >200 ms. The combination of RBBB, LAFB and First degree AVB is called Trifascicular block, which indicate presence of severe disease of heart electrical conduction system. Besides trifascicular block, important fin

74 years old patient with palpitations and history of myocardial infarction In this ECG is present  wide complex tachycardia  (QRS duration >120ms) with heart rate ~180/min. The main differential diagnosis of Wide Complex Tachycardias are:                     a)        Ventricular tachycardia                         b)        Supraventricular tachycardia with RBBB or LBBB                    c)        Supraventricular tachycardia with pre excitation. In this case, ECG findings strongly support  Atrial fibrillation with LBBB  (Supraventricular tachycardia with LBBB) before VT or pre excitation. First of all the rhythm is irregularly irregular and no supraventricular activity is present. This is very typical for atrial fibrillation. QRS complexes have typical morphology for  LBBB  (QS in V1 and notched R wave in lead V6). There is no electrocardiographic features for ventricular tachycardia present. No  AV dissociation, no positive or negative concordan

This ECG was registered in 75 years old patient with abdominal pain Which abnormality can you spot on this ECG? a. STEMI b. NSTEMI c. First degree AVB d. Second degree AVB e. Third Degree AVB f. Acute epricarditis g. BER

Patient with history of cardiac disease, hemodynamically unstable. What is your diagnosis?

In a rhythm strip A , presents Pulmonary P wave that suggests right atrial enlargement. P wave with duration less than 120ms and amplitude more than 2.5mm.  In a rhythm strip B , presents Mitrale P wave that suggests left atrial enlargement. P wave with duration more than 120 ms and amplitude less than 2.5mm.  In a rhythm strip C , presents Biphasic P wave with terminal negative portion more than 40 ms and more than 1mm deep which suggests left atrial enlargement.  In a rhythm strip D, presents Inverted P wave preceding each QRS complex with normal PR interval that suggest low atrial rhythm.  In a rhythm strip E , presents Normal P wave that suggests normal sinus rhythm.

25 years old male with persistent burning chest pain since 5 hour. No risk factor for heart disease. Troponins negative. What is your diagnosis and what to do further? (Pacienti mashkull 25 vjeq me dhimbje djegëse të gjoksit qe 5 orë. Pa faktor risku për sëmundje kardiake. Troponinat negative. Cila është diagnoza juaj dhe cka do bënit tutje?)