ECG.CASES

#case202 ❤️

After cardioversion

P waves are shown with arrows

• The ECG shows a wide complex tachycardia at a rate of ~175 bpm. Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.
• STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.

The correct answer is “Acute myocardial infarction complicated by Ventricular tachycardia”

55 year old man, known case of CKD presented with sudden onset chest pain and palpitation.

#case201 ❤️

The ECG shows upslope ST-Depressions and peaked T waves in the anterior leads. this pattern is called “De Winter T wave” and seen in ~2% of acute LAD occlusions.

The correct answer is “Left anterior descending artery (LAD)”

75 year old man with 2 hours chest pain.

#case200 ❤️

ECG features:
• Narrow complex tachycardia at ~160 bpm.
• Sawtooth flutter waves are seen best in the inferior leads (II, III, and aVF)
• There is a clear 2:1 relationship between the flutter waves (~320 bpm) and QRS complexes (~160 bpm).

The correct answer is “Atrial flutter”

55 y female with history hypothyroidism presented with palpitation and lightheadedness.

#case199 ❤️