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70 yr old with lethargy and presyncope

70 yr old with lethargy and presyncope. Type II AV block – Mobitz II. Same patient few minutes later. Type II block – Wenkebach/Mobitz I . Same patient yet again…. Complete heart block – Third degree block. 70 yr old with lethargy and syncope.

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70 yr old with lethargy and presyncope

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  1. 70 yr old with lethargy and presyncope Type II AV block – Mobitz II

  2. Same patient few minutes later Type II block – Wenkebach/Mobitz I

  3. Same patient yet again… Complete heart block – Third degree block

  4. 70 yr old with lethargy and syncope Trifascicular block – 1st degree HB, RBBB and LAD (L anterior hemiblock)

  5. 50 yr old with palpitations Capture beats Fusion beat Monomorphic VT

  6. R on T causing polymorphic VT = Torsade's du pointe

  7. You don’t want this for your patient Ventricular Fibrillation

  8. 30 yr old male with syncope Brugada Syndrome

  9. Brugada Syndrome • ECG Findings • Three types • ST elevation v1 – v3 > 2mm • Complete or incomplete RBBB • T-wave α types • 1. Inverted • 2. Biphasic • 3. Upright

  10. Brugada – Why do we care? • Predisposition to polymorphic ventricular tachycardia • Identification and treatment with AICD may prevent a young sudden cardiac death

  11. 25 year old with syncope on exercising Arrthymogenic RV cardiomyopathy/dysplasia - inverted T waves in leads V1 through V5. Arrowheads point to late RV activation, called an epsilon wave

  12. When to refer cardiac syncope to ED • All 2nd degree and 3rd degree heart blocks • All trifascicular blocks • All rapid AF >120 • All SVTs in not terminated by Valsalva manouvre • “funny looking” ST/T segments – discuss/fax • Asymptomatic patients with WPW, ST changes can be referred to cardiology OPA

  13. Important contact details for Northern Hospital Nov 2013 Clinical ED Consultant – 8405 2610/8405 8610 ED Fax – 8405 8633 EMET/General enquiries – 8405 8013 (Kim Tarzia ED secretary) EMET queries to Dr Cynthia Lim, Dr Peter Jordan, Dr Megan Robb ED Director – Dr ShyamanMenon EMET presentations : www.nhedventures.com Adult Outpatients – 8405 8850/8405 8335 Fax – 8405 8761 Cardiology – 8405 8859 Fax – 8405 8405 (currently 3 month wait for Chest pain clinic) Paediatric/Paed Surgery OPA – 8405 8417 Fax – 8405 8449 (current 4-6 week)(apmt sent 1 week) Paediatric Surg Fax – 8405 8449 (within a week)

  14. www.nhedventures.com Click on EMET on left to access presentations provided. Registrar education sessions and interesting education links

  15. 70 yr old with lethargy and presyncope Type II AV block – Mobitz II

  16. Same patient few minutes later Type II block – Wenkebach/Mobitz I

  17. Same patient yet again… Complete heart block – Third degree block

  18. 70 yr old with lethargy and syncope Trifascicular block – 1st degree HB, RBBB and LAD (L anterior hemiblock)

  19. 50 yr old with palpitations Capture beats Fusion beat Monomorphic VT

  20. R on T causing polymorphic VT = Torsade's du pointe

  21. You don’t want this for your patient Ventricular Fibrillation

  22. 30 yr old male with syncope Brugada Syndrome

  23. Brugada Syndrome • ECG Findings • Three types • ST elevation v1 – v3 > 2mm • Complete or incomplete RBBB • T-wave α types • 1. Inverted • 2. Biphasic • 3. Upright

  24. Brugada – Why do we care? • Predisposition to polymorphic ventricular tachycardia • Identification and treatment with AICD may prevent a young sudden cardiac death

  25. 25 year old with syncope on exercising Arrthymogenic RV cardiomyopathy/dysplasia - inverted T waves in leads V1 through V5. Arrowheads point to late RV activation, called an epsilon wave

  26. When to refer cardiac syncope to ED • All 2nd degree and 3rd degree heart blocks • All trifascicular blocks • All rapid AF >120 • All SVTs in not terminated by Valsalva manouvre • “funny looking” ST/T segments – discuss/fax • Asymptomatic patients with WPW, ST changes can be referred to cardiology OPA

  27. Important contact details for Northern Hospital Nov 2013 Clinical ED Consultant – 8405 2610/8405 8610 ED Fax – 8405 8633 EMET/General enquiries – 8405 8013 (Kim Tarzia ED secretary) EMET queries to Dr Cynthia Lim, Dr Peter Jordan, Dr Megan Robb ED Director – Dr ShyamanMenon EMET presentations : www.nhedventures.com Adult Outpatients – 8405 8850/8405 8335 Fax – 8405 8761 Cardiology – 8405 8859 Fax – 8405 8405 (currently 3 month wait for Chest pain clinic) Paediatric/Paed Surgery OPA – 8405 8417 Fax – 8405 8449 (current 4-6 week)(apmt sent 1 week) Paediatric Surg Fax – 8405 8449 (within a week)

  28. www.nhedventures.com Click on EMET on left to access presentations provided. Registrar education sessions and interesting education links

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