ECG.CASES

thanks to my friend Dr.Salvatore for the beautiful scheme

High grade AV block is a type of 2nd degree heart block with a conduction ratio of 3:1, 4:1 or higher. Although AV dissociation is evident in the ECG, Unlike 3rd degree heart block, there is still some relationship between the P waves and the QRS complexes, Indicating the heart block is not “complete”. High-grade AV block may result from either Mobitz I or Mobitz II AV block. In response to extremely slow ventricular rate, junctional escape beats are generated to maintain contraction of the ventricles.

The correct answer is “High grade AB block”

53 y female presented with palpitation

#case187 ❤️

There is a predictable pattern of sinus beats followed by a pause creating group beats.The P-P interval during the pause has a duration that is approximately equal to two P-P cycles. All PR intervals are the same and QRS complexes follow all the P waves. These findings are consistent with type 2 sinoatrial exit block. Note that the pause duration in type I SA block l is less than two P-P cycles (in contrast to this ECG)

The correct answer is “Sinus exit block (sinoatrial exit block)”

60 y man presented with several episodes of syncope in the past week

#case186 ❤️

A 20 y male has had several syncopal episodes in the past 6 month. very strong family Hx of syncope and sudden cardiac death

#Extra05 ❤️

The ECG shows the S1Q3T3 pattern. This “classic” finding is neither sensitive nor specific for PTE and found in only 20% of patients with PTE. Thus, ECG findings only in combination with physical symptoms suggest PTE. Although ST-elevation may be seen in the PTE, in this case they are due to early repolarization.

Here are the most common ECG findings in patients with PTE:

• Sinus tachycardia
• S1Q3T3 pattern
• New-onset atrial fibrillation or flutter
• incomplete right bundle branch block
• right axis deviation
• T-wave inversion in leads V1 to V4

The correct answer is “Pulmonary thromboembolism (PTE)”