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

The name of QRS complexes is as following:  1.Rs, 2.qRs, 3.QS, 4.RS, 5.QR, 6.rsR', 7.R, 8.rS, 9.RR'.

This ECG shows: a) Sinus rhythm with LBBB b) Atrial fibrillation with LBBB c) Ventricular tachycardia with LBBB morphology?

What is your diagnosis and the best treatment? In this ECG Case we can't identify any P waves, QRS complexes or T waves. All what we can see is chaotic irregular ventricular deflections of varying amplitude and frequency >400/min. This findings are features of Ventricular fibrillation • Ventricu lar fibrillation can be coarse and fine. Coarse ventricular fibrillation occurs earlier after the onset of cardiac arrest and has high amplitude fibrillatory waves. In opposite, fine ventricular fibrillation occurs more later, is less organized with lower amplitude fibrilatory waves. • Coarse ventricular fibrillation frequently looks like TDP or Non-TDP polimorphyc VT. • Previus ECG of this patient did not have a long QT. This fact is against TDP.  In conclusion patient was hemodynamically unstable so in this moment it is not important to differentiate Coarse VFib from TDP. Gave unsynchronized cardioversion (Defibrillation) to the patient.

25 years old male with palpitations. What is your plan for further management of this case. Brugada syndrome is rare cardiac disease with genetic substrate. ECG featuring for Brugada Syndrome is RBBB (or incomplete RBBB) with ST elevation in right precordial leads. Diagnosis is based on this specific ECG pattern, observed either spontaneously or during provocation tests such is Ajmalin test. Genetic test and electrophysiological studies can be uses too, to make the diagnosis of this disease and to assess the risk of sudden death from cardiac arrhythmias. Brugada represent high risk for sudden cardiac death.