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ECG etc… (Miscellaneous ECGs)

ECG etc… (Miscellaneous ECGs). Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center. Describe the following miscellaneous ECGs: Lead reversal Dextrocardia Hypothermia Pericarditis Cardiac Tamponade Wolff-Parkinson-White Pulmonary embolism

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ECG etc… (Miscellaneous ECGs)

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  1. ECG etc…(Miscellaneous ECGs) Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center

  2. Describe the following miscellaneous ECGs: Lead reversal Dextrocardia Hypothermia Pericarditis Cardiac Tamponade Wolff-Parkinson-White Pulmonary embolism Practice, practice, practice!!! Objectives

  3. Limb lead reversal Inverted P and QRS in lead I

  4. Chest lead reversal Tall precordial R waves

  5. Normal ECG

  6. Dextrocardia Negative P and QRS in lead I and aVL Reverse R wave progression (differential: lead reversal)

  7. Hypothermia Osborn or “J” waves (arrows) Baseline interference from shivering (others: sinus brady, QT prolongation, junctional rhythm, ventricular fibrillation, asystole)

  8. Hypothermia

  9. Pericarditis Diffuse ST elevations Typically, no reciprocal changes PR displacement

  10. Pericarditis

  11. Cardiac Tamponade • Tamponade Triad (specific, not sensitive): • Sinus tachycardia • Low voltage QRS • Electrical alternans

  12. Wolff-Parkinson-White • WPW Triad: • Short PR interval • Wide QRS • Delta wave

  13. A. Fib with WPW

  14. Pulmonary Embolism Clues: Sinus tachycardia S1Q3T3 pattern Incomplete RBBB with R precordial T wave inversions

  15. PE

  16. Lets’ practice!

  17. EKG 1

  18. EKG 2

  19. EKG 3

  20. EKG 4

  21. EKG 5

  22. EKG 6

  23. EKG 7

  24. EKG 8

  25. 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

  26. The End

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