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Ecg

Discussion in 'Spot Diagnosis' started by kangourou, Dec 19, 2012.

  1. kangourou

    kangourou Famous Member

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    Case: 62 year old man attends emergency department with shortness of breath and recurrent episodes of syncope. He is known to have chronic obstructive pulmonary disease (COPD) and has smoked heavily for 40 years. All we know about his medications so far is that he takes something for his blood pressure and has inhalers for his COPD. He does not normally require O2 at home. He is currently pyrexial. His blood pressure is 110/70, he is normally hypertensive. He is tachycardic with an irregular pulse. Arterial blood gas shows a mixed respiratory and metabolic acidosis. His saturations are 85% on 15L of O2. You do an ECG which shows the following:

    ECG1.jpg

    I have provided a case to go with this ECG for completeness. What does this ECG show? (Please click on the image to see it in full size).
     

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  2. neo_star

    neo_star Moderator

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    Anteroseptal MI + lateral wall ischemia in the setting of A fib ( not sure ) with variable block ( demonstrated by the varying rhythm ) witha component of fasicular block.

    Really nice one, thanks and educate me further
     

  3. dilsh123

    dilsh123 Young Member

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    Multifocal atrial tachicardia
     

  4. Carmen

    Carmen Active member

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    Maybe is a ECG of patient with cardiac hypertrophy
     

  5. Stefan Misaca

    Stefan Misaca Famous Member

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    Anteroseptal MI + left ventricular hypertrophy
     

  6. danielmx

    danielmx Active member

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    Atrial fibrilation + Left ventricular hypertrophy + probable NSTEMI / Myocardial Ischemia / PE

    i'd take troponin I and T levels, LDH, myoglobin and BNP

    i could not differentiate this from PE or MI without labs, or anything more than "shortness of breath". That ST elevation does not convince me, a real MI usually doesn't make you count the Ashman units, they tend to be very straightforward, yet this oculd be NSTEMI or Unstable angina (which would be weird without previous episodes).

    PE: pulmonary embolism
    NSTEMI: Non-St elevation myocardial infarction
    BNP: brain natriuretic peptide
    LDH; lactate dehydrogenase
     

    Last edited: Dec 21, 2012
  7. dr.angela

    dr.angela Bronze Member

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    LVH +lataral ischemia,Af
     

  8. fddiver2

    fddiver2 Young Member

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    LVH and Uncontrolled Atrial Fib. Controlling his rate may help with the dyspnea and syncopal episodes. You could try Diltiazem or do a TEE to ensure there are no clots and Sync Cardioversion (if he is already anti coagulated)
     

  9. NinaSlavova

    NinaSlavova Well-Known Member

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    Miocarditis
     

  10. Marty

    Marty Well-Known Member

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  11. Gabby Lucy

    Gabby Lucy Active member

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    LVH, NSTEMI
     

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