ECG QUIZClassic Tracings for Family Physicians

Dr. Mathieu Walker

Associate Professor of Medicine, McGill University

Cardiology Divisional Director, Saint Mary’s Hospital

November 26th, 2018

Session Objectives

1. To help you recognize some classic ECG patterns

2. To review an approach to SVT diagnosis

3. To introduce/review the Modified Valsalva maneuver

4. To teach you some of my favorite “ECG pearls”

5. For you to have some fun and test your ECG interpretation skills!

The presentation slides in their entirety will be posted after the

lecture

Narrow complex tachycardia – Specific Dx?

Match each figure on the left with the arrhythmia on the right

1. Atrial fibrillation2. Multifocal atrial

tachycardia (MAT)3. AV node reentry

tachycardia (AVNRT)4. Atrioventricular reentry

tachycardia - AVRT (orthodromic)

5. Atrioventricular reentry tachycardia-AVRT (antidromic)

6. Atrial flutter7. Atrial tachycardia

N Engl J Med 2012;

367:1438-1448

Another SVT case: Can you see P waves?

Identify the rhythm

Explain the change in QRS morphology halfway through the tracing

Explain the change in QRS morphology

Diagnosis? Treatment in the symptomatic pt?

Grouped Beating

Does this patient have evidence of an old myocardial infarction?Why is the 5th QRS complex different?

What is the rhythm?

What arrhythmia is this patient at risk for developing?

You are presented with this rhythm strip in the E.D. What is your immediate management?

Rhythm strip

Rhythm?

What rhythm is shown? Treatment?

. Sinus tachycardia . Low voltage, extremity and precordial leads . Nonspecific T abnormalities, lateral leads

918559 26-Mar-2010 10:55:33GROS , MONICA

DOB: 24-Feb-1962 48 Years Female Dept: ER

4Room:

Oper: MN

HR 124

PR 122

QRSD 58

QT 298

QTc 428

-- AXIS --

P 27

QRS 74

Requested By: DRUMMOND, D.

Patient Code:OUT

Standard 12- ABNORMAL ECG -

CONFIRMED BY : Derek Marpole, M.D. 26-Mar-2010 14:02:50SMHC - Main Campus (100-10000-07)

I

II

III

aVR

aVL

aVF

V1

V2

V3

V4

V5

V6

II

Chest: 10 mm/mVLimb: 10 mm/mVSpeed: 25 mm/secDevice: BME 04838 F 60~ 0.5-40 Hz W PH100B L P?

65 year old woman with metastatic breast cancer. Hypotensive.Most likely diagnosis?

Identify the rhythm

58M with retrosternal chest pain.What is the most likely diagnosis?

Which cardiac chamber is abnormal in this patient?

What is the rhythm? What is the cause? What treatment do you recommend?

What electrolyte abnormality is present?

Worsening electrolyte abnormality