ECG etc… (Miscellaneous ECGs) Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center
Feb 11, 2016
ECG etc…(Miscellaneous ECGs)
Rey Vivo, MDAssistant Professor of Medicine
Texas Tech University Health Sciences Center
Objectives
• Describe the following miscellaneous ECGs:– Lead reversal– Dextrocardia– Hypothermia– Pericarditis– Cardiac Tamponade– Wolff-Parkinson-White– Pulmonary embolism
• Practice, practice, practice!!!
Limb lead reversal
Inverted P and QRS in lead I
Chest lead reversal
Tall precordial R waves
Normal ECG
Dextrocardia
Negative P and QRS in lead I and aVLReverse R wave progression(differential: lead reversal)
Hypothermia
Osborn or “J” waves (arrows)Baseline interference from shivering
(others: sinus brady, QT prolongation, junctional rhythm,ventricular fibrillation, asystole)
Hypothermia
Pericarditis
Diffuse ST elevationsTypically, no reciprocal changes
PR displacement
Pericarditis
Cardiac Tamponade
Tamponade Triad (specific, not sensitive):1. Sinus tachycardia2. Low voltage QRS
3. Electrical alternans
Wolff-Parkinson-White
WPW Triad:1. Short PR interval
2. Wide QRS3. Delta wave
A. Fib with WPW
Pulmonary Embolism
Clues:Sinus tachycardiaS1Q3T3 pattern
Incomplete RBBB with R precordial T wave inversions
Lets’ practice!
EKG 1
EKG 2
EKG 3
EKG 5
EKG 7
EKG 8
Brugada syndrome• Defined in 1992 by brothers Pedro and Josep
Brugada in J Am Coll Cardiol• Rare condition associated with sudden cardiac death (SCD) or ventricular
fibrillation/polymorphic VT in structurally normal hearts• Mean age of presentation: 35-40 years; male predominance (notably in SE
Asia where it is endemic)• Familial with autosomal dominant inheritance• Clinical presentation: syncope or SCD is most common initial event;
typically occurs in sleep or in early morning• ECG criteria: ST segment elevation in V1-V3 with characteristic RBBB
pattern• Defect in sodium channel gene (SCN5A) on chromosome 3• Lifetime risk of SCD• Consider ICDs; refer for genetic counseling
The End