ECG Cases

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.

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.