Ecg commentary from saudi arabia 2004 white

ECG Commentary

Samir Morcos Rafla, FESC, FACC

Professor of Cardiology

Alexandria University

These ECGs are from Saudi Arabia Conference 2004, I was speaker and chairperson

33 yr old female pregnant 12 weeks not responding to

medications. What to do?

Case 5: 33 yr old female pregnant 12

weeks not responding to medications.

Incessant atrial tachycardia, EF 35%, HR

during sleep 110, awake 150. Given

Flecainide gradually in ICU with B-

Blockers. Delivered at 29 weeks. The baby

was put in incubator, developed normally

thereafter. Ablation was done, LA focus.

EF improved.

VT 205/min, LBBB with right axis

Remember right ventricular dysplasia

6 months old infant presenting with dilated cardiomyopathy. The following 15 leads electrogram was obtained during the evaluation. What is your diagnosis?

Sinus tachycardia, rate 154/min.

Cath. was done

Anomalous left coronary artery

10 year old girl who is asymptomatic and found to have this

ECG. Q: What are the ECG findings?

Your diagnosis please?

Prolonged QT, 0.50 sec

Note T wave changing morphology

Management: maximum tolerated dose of

beta blockers, stop any causative drugs if

any.

Brugada syndrome. Brother died

suddenly.

ICD is indicated.

Case 32: 14 yr old male, healthy,

complains of tachycardia.

Wide QRS tachycardia with retrograde P,

LBBB.

Junctional ectopic tachycardia, HR 102.

Management: --

Case 33: DDD pacemaker, biventricular,

unipolar

34: DDD, bipolar, LV off, atrium and RV

only.

35: RV off.

ECG recordings from leads II, aVF, and V5 in three patients from families with long QT syndrome linked to genetic markers on chromosomes 3,7, and 11. None of the patients were receiving -adrenergic blocking medication at the time the ECGs were obtained. Chromosome 3, 15-year-old boy (family 1) with a mutation in the cardiac sodium channel gene SCN5A; the heart rate is 42 beats per minute (bpm), and the QTc in lead II is 570 ms with late-onset T waves of normal duration and amplitude.

Chromosome 7, 21-year-old woman (family 3); the heart rate is 57 bpm, and the QTc in lead II is 583 ms with low-amplitude T waves.

Chromosome 11, 31-year-old woman (family 6); the heart rate is 79 bpm, and the QTc in lead II is 573 ms with early onset of broad-based T waves

Case 38: Inf. MI. Bradycardia dependent

block. No pacemaker or EPS are needed.

Case-1 : 14 years old boy, asymptomatic 1- Describe the rhythm 2- What is the treatment?

Case 39: 14 years old boy, asymptomatic.

Accelerated idioventricular rhythm, fusion beats, focus in RV.

40: Same patient Holter

Note at fast HR, sinus rhythm. At slower HR, ventricular rhythm.

Management: nothing, benign rhythm.

Same patient Holter - Note at fast HR, sinus rhythm. At slower HR, ventricular rhythm.

Case 43 : 1 year old girl with cardiomyopathy

What is the most likely diagnosis?

Case 43: 1 year old girl with

cardiomyopathy.

SVT 170, AVNRT or atrial tachycardia or

accelerated conduction.

44: Holter same patient: At slower rate, p

waves. Atrial tachycardia leading to

cardiomyopathy.

Holter same pt. At slower rate, p waves seen. Management: Ablation

Case-4 : 8 years old boy with syncope QT 0.48 See Holter below: Torsade de pointe

Case-5 Neonate With frequent bradycardia-Holter

Case 46: Neonate with frequent

bradycardia.

2:1 conduction. Normal AV node,

isoprenaline was given by mistake,

leading to 1:1 conduction.

Management: Flecainide.

Case-6 Neonate with bradycardia What is the diagnosis? What is the underlying etiology?

Case 47: QT 0.6 sec. 2:1. Holter: repeated

Torsades de Pointes.

Management: Pacemaker + B-Blockers.

Case-7 : Neonate with bradycardia What is the diagnosis? What is the treatment?

Case 48: Neonate with Complete Heart

Block. Narrow QRS, HR 75. Mother has

SLE.