ECG of the Week - 30th December 2013

This ECG follows on the case of our patient from last week.
Following an out-of-hospital cardiac arrest the patient, a 58 yr old male, presented with ROSC.
Initial treatment included iv adrenaline infusion and external pacing, followed by placement of a transvenous pacing wire. The resultant ECG is below.

ECG of the Week - 23rd December 2013 - Interpretation

The following ECG is from a 58yr old male who was brought to the Emergency Department following an out-of-hospital cardiac arrest. 
The initial rhythm on paramedic arrival was VF, initial DC cardioversion resulted in PEA with ROSC following iv adrenaline. A further episode of pre-hospital VF responded to DC cardioversion.
On arrival to the Emergency Department the patient is intubated, starting to make voluntary movements, with eye opening to stimuli. Vital signs: BP 98/67, BSL 8.2, Temp 36.8
Check out the comments on this case here.
The initial ECG is below:

ECG of the Week - 23rd December 2013

The following ECG is from a 58yr old male who was brought to the Emergency Department following an out-of-hospital cardiac arrest. 
The inital rhythm on paramedic arrival was VF, initial DC cardioversion resulted in PEA with ROSC following iv adrenaline. A further episode of pre-hospital VF responded to DC cardioversion.
On arrival to the Emergency Department the patient is intubated, starting to make voluntary movements, with eye opening to stimuli. Vital signs: BP 98/67, BSL 8.2, Temp 36.8
The initial ECG is below:

ECG of the Week - 16th December 2013 - Interpretation

This week's ECG is from a 72 yr old male.
He was referred in to the Emergency Department by his GP having complained of nausea, lethargy, and anorexia for the preceding week. Past History of chronic renal failure,and ischaemic heart disease with previous 2 vessel PCI. Medications included frusemide, ACE-inhibitor, and a statin.
Check out the comments from our original post here.

ECG of the Week - 16th December 2013

This week's ECG is from a 72 yr old male.
He was referred in to the Emergency Department by his GP having complained of nausea, lethargy, and anorexia for the preceding week. Past History of chronic renal failure,and ischaemic heart disease with previous 2 vessel PCI. Medications included frusemide, ACE-inhibitor, and a statin.

ECG of the Week - 9th December 2013 - Interpretation

This week's ECG is from a 58 yr old male who presents to the Emergency Department c/o palpitations, dizziness, and chest pain. Symptoms onset ~90 mins prior to presentation.Past Hx - hypertension, hyperlipidaemia.
Check out the comments on our original post here.

ECG of the Week - 9th December 2013

This week's ECG is from a 58 yr old male who presents to the Emergency Department c/o palpitations, dizziness, and chest pain. Symptoms onset ~90 mins prior to presentation.
Past Hx - hypertension, hyperlipidaemia. 

ECG of the Week - 2nd December 2013 - Interpretation

This week's ECG is from a 68yr old female who presents complaining of palpitations intermittently over the last 4 days with a concurrent viral upper respiratory tract infection. She has a history of paroxysmal atrial fibrillation and mitral valve replacement (St Jude's) and medications include warfarin and sotalol.

You can check out the comments on our original post here.

ECG of the Week - 2nd December 2013

This week's ECG is from a 68yr old female who presents complaining of palpitations intermittently over the last 4 days with a concurrent viral upper respiratory tract infection. She has a history of paroxysmal atrial fibrillation and mitral valve replacement (St Jude's) and medications include warfarin and sotalol.

ECG of the Week - 25th November 2013 - Interpretation

This week's ECG is from a 56 yr old male who presented with episodic chest pain over the preceding few days. He is a hypertensive smoker. He was pain free when this ECG was performed.
Check out our original post and comments here.

ECG of the Week - 25th November 2013

This week's ECG is from a 56 yr old male who presented with episodic chest pain over the preceding few days. He is a hypertensive smoker. He was pain free when this ECG was performed.

ECG of the Week - 18th November 2013 - Interpretation

This week's ECG is from a 65 yr old male who presents with chest pain.
Intermittent exertional chest pain over the preceding week .
Continuous chest pain for the last hour with dysponea and diaphoresis.
Past history of hypertension. Non smoker with no family history.
Check out the comments on our original post here.

ECG of the Week - 18th November 2013

This week's ECG is from a 65 yr old male who presents with chest pain.
Intermittent exertional chest pain over the preceding week .
Continuous chest pain for the last hour with dysponea and diaphoresis.
Past history of hypertension. Non smoker with no family history.

ECG of the Week - 11th November 2013 - Interpretation

I'm busy updating my ECG collection so I'm using some of the older ECG's I've collected. Unfortunately many of these, including this week's ECG, don't have any associated clinical information. I will try and track down some information on this case and will update the post if I find any.
Even without any clinical information it's still a nice ECG :-)
Check out the comments on our original post here.

ECG of the Week - 11th November 2013

I'm busy updating my ECG collection so I'm using some of the older ECG's I've collected. Unfortunately many of these, including this week's ECG, don't have any associated clinical information. I will try and track down some information on this case and will update the post if I find any.
Even without any clinical information it's still a nice ECG :-)

ECG of the Week - 4th November 2013 - Interpretation

Unfortunately I've got no clinical information on this case but the ECG looks interesting.

ECG of the Week - 4th November 2013

Unfortunately I've got no clinical information on this case but the ECG looks interesting.

ECG of the Week - 28th October 2013 - Interpretation

This ECG is from a 35 yr old male who presented to the Emergency Department complaining of palpitations, dysponea, and light-headedness for the preceding hour. He has no known past medical history.
Vital signs: BP 115/65, RR 20, Sats 98% RA, T 36.6
Check out the extensive comments on our original post here

ECG of the Week - 28th October 2013

This ECG is from a 35 yr old male who presented to the Emergency Department complaining of palpitations, dysponea, and light-headedness for the preceeding hour. He has no known past medical history.
Vital signs: BP 115/65, RR 20, Sats 98% RA, T 36.6

ECG of the Week - 21st October 2013 - Interpretation

This week case includes three ECG's from the same patient.
They are from a 74 yr old patient who I assume had multiple medical co-morbidities.
The patient presented having had several episodes of chest pain in the preceding 24 hours.
Check out our comments from the original case post here.

ECG of the Week - 21st October 2013

This week case includes three ECG's from the same patient.
They are from a 74 yr old patient who I assume had multiple medical co-morbidities.
The patient presented having had several episodes of chest pain in the preceding 24 hours.

ECG of the Week - 14th October 2013 - Interpretation

This ECG is from a 24 year old male who presents with chest pain.
He is normally fit & well.
Vital signs: BP 134/76 RR 16 Sats 99% RA Temp 36.8
Check out the comments at our original post here.

ECG of the Week - 14th October 2013

This ECG is from a 24 year old male who presents with chest pain.
He is normally fit & well.
Vital signs: BP 134/76 RR 16 Sats 99% RA Temp 36.8
Our interpretation post for this ECG can be found here.

ECG of the Week - 7th October 2013 - Intepretation

This is one of the older ECG's I've got in my collection and as such I've got very little clinical information on the case except it is from a 71 year old female.
Please check out the great comments from our readers  on this ECG at our original post here.

ECG of the Week - 7th October 2013

This is one of the older ECG's I've got in my collection and as such I've got very little clinical information on the case except it is from a 71 year old female.

ECG of the Week - 30th September 2013 - Interpretation

This ECG is from a 88 year old male who presents following multiple episodes of pre-syncope during the day. Past history of hyperlipidaemia, hypertension, atrial fibrillation, and CVA.

Medications include warfarin, metoprolol, and a diuretic. He is not taking digoxin or other antiarrhythmics.
Check out the extensive and excellent comments on these ECG's from our original case post here. 

Welcome to our new commenters Agus, Mohammed, Charles, and Mike.
I hope you enjoy the blog.

ECG of the Week - 30th September 2013

This ECG is from a 88 year old male who presents following multiple episodes of pre-syncope during the day. Past history of hyperlipidaemia, hypertension, atrial fibrillation, and CVA.
Medications include warfarin, metoprolol, and a diuretic. He is not taking digoxin or other antiarrhythmics.

ECG of the Week - 23rd September 2013 - Interpretation

A 73yr old female presents following an episode of syncope.
She is on no medication and has the following vitals:
BP 114/65 RR 18 Sats 97% (RA), Temp 36.3, BSL 6.5
Her ECG is below.
Check  out our original post and the excellent comments here.

ECG of the Week - 23rd September 2013

A 73yr old femlae presents following an episode of syncope.
She is on no medication and has the following vitals:
BP 114/65 RR 18 Sats 97% (RA), Temp 36.3, BSL 6.5
Her ECG is below.

ECG of the Week - 16th September 2013 - Interpretation

This ECG is from a 69 year old male who had a dual chamber pacemaker inserted earlier in the day. He complained to the ward staff of pain at the insertion site and you've been asked to review him. His BP, temp, sats, resp rate are all within normal limits.

An ECG and CXR are performed, results below.
Check out the comments on this case here.

ECG of the Week - 16th September 2013

This ECG is from a 69 year old male who had a dual chamber pacemaker inserted earlier in the day. He complained to the ward staff of pain at the insertion site and you've been asked to review him. His BP, temp, sats, resp rate are all within normal limits.

An ECG and CXR are performed, results below.

ECG of the Week - 9th September 2013 - Interpretation

This very unique ECG has kindly been donated by a member of our blog team Dr A Keren, a consultant cardiologist and cardiac electrophysiologist.
This ECG is from a middle aged female with a history of cardiac failure. 
Check out the comment's from our original post here.

ECG of the Week - 9th September 2013

This very unique ECG has kindly been donated by a member of our blog team Dr A Keren, a consultant cardiologist and cardiac electrophysiologist.
This ECG is from a middle aged female with a history of cardiac failure. 
You can find our full interpretation of this ECG here.

ECG of the Week - 2nd September 2013 - Interpretation

This ECG is from a 39 yr old male who presented with 2 hours of chest pain. 
Strong family history of cardiac disease. 
Nil regular meds. BP 134/78. Sats 98% RA
Check out the excellent comments on this ECG in our original case post here.

ECG of the Week - 2nd September 2013

This ECG is from a 39 yr old male and I can only assume he presented with chest pain.
I will get some more clinical information today and update the case this evening, including our 'VAQ Corner' exam style quesion.

Updated.

This patient presented with 2 hours of chest pain. Strong family history of cardiac disease. 
Nil regular meds. BP 134/78. Sats 98% RA
VAQ Corner question also added.

Our interpretation of this case can be found here.

ECG of the Week - 26th August 2013 - Interpretation

This ECG is from an 85yr old female who presented complaining of worsening dysponea and atypical chest pain. She has known atrial fibrillation and COPD. 
At the time of clinical review we luckily had access to her old ECG's and a recent echo.
I plan to include her echo results with the interpretation post although the ECG might give some clues as to the findings.
Check out the original post and comments here.

ECG of the Week - 26th August 2013

This ECG is from an 85yr old female who presented complaining of worsening dysponea and atypical chest pain. She has known atrial fibrillation and COPD. 
At the time of clinical review we luckily had access to her old ECG's and a recent echo.
You can find the patient's echo result and a bit more information in our interpretation post for this ECG here.

ECG of the Week - 19th August 2013 - Interpretation

Again unfortunately no clinical information on this case, but that's never stopped us before.
Check out the comments on our original case post here. 

ECG of the Week - 19th August 2013

Again unfortunately no clinical information on this case, but that's never stopped us before.

Thanks to Ken for reminding me to add a link here to our interpretation of this ECG.

ECG of the Week - 12th August 2013 - Interpretation

I unfortunately have no clinical information on this ECG, but it looks interesting :-)
Check out our original post of this ECG and the excellent comments here.

ECG of the Week - 12th August 2013

I unfortunately have no clinical information on this ECG, but it looks interesting :-)

ECG of the Week - 5th August 2013 - Interpretation

This ECG is from a 28 year old male who presented following a fall from height, 2 metres, and complained of mild left chest & arm pain. His vital signs are all normal.
Check out the original post to see a collection of excellent comments on this ECG.

ECG of the Week - 5th August 2013

This ECG is from a 28 year old male who presented following a fall from height, 2 metres, and complained of mild left chest & arm pain. His vital signs are all normal.
An ECG was performed, see below, thoughts, comments ?
Check out our interpretation, and some more information on the clinical outcome, here.

ECG of the Week - 29th July 2013 - Interpretation

This ECG is from a 49yr old who presented complaining of palpitations and feeling lightheaded.
On multiple medications including amiodarone, ACE-inhibitor, digoxin, and a beta-blocker.
Hx of cardiomyopathy with AICD in situ.

Check out the original post of this case including a number of excellent comments here.

ECG of the Week - 29th July 2013

This ECG is from a 49yr old who presented complaining of palpitations and feeling lightheaded.
On multiple medications including amiodarone, ACE-inhibitor, digoxin, and a beta-blocker.
Hx of cardiomyopathy with AICD in situ.

ECG of the Week - 22nd July 2013 - Interpretation

This one is from a male presenting with 2 hours of central chest pain which was ongoing at the time of ECG recording.
You can see the original post with an extensive collection of excellent comments here.

ECG of the Week - 22nd July 2013

This one is from a male presenting with 2 hours of central chest pain which was ongoing at the time of ECG recording.

Brugada 'Editorial' by Dr Ken Grauer

Guest 'Editorial' by Dr Ken Grauer author of ECG Interpretation Blog

Dr Grauer posted an extensive 'editorial' comment on our ECG case from this week, a young patient with Type 1 Brugada, syncope, and recurrent epsiodes of VF.
To avoid people missing this comment I've created this special 'Editorial' post.

ECG of the Week - 15th July 2013 - Interpretation

This ECG is from a 53 yr old male.
Presented to the ED following an episode of collapse.
You can view our original post and the associated comments here.

ECG of the Week - 15th July 2013

This ECG is from a 53 yr old male.
Presented to the ED following an episode of collapse.

ECG of the Week - 8th July 2013 - Interpretation

This ECG is from a 47 year old female.
She presents with acute onset severe dysponea.
Vitals signs are BP 95/42 RR 30 Sats 88% (Room Air)
Her ECG is below.

ECG of the Week - 8th July 2013

This ECG is from a 47 year old female.
She presents with acute onset severe dysponea and pre-syncope.
Vitals signs are BP 95/42 RR 30 Sats 88% (Room Air)
Her ECG is below.

ECG of the Week - 1st July 2013 - Interpretation

I don't have any clinical information on this ECG unfortunately.

ECG of the Week - 1st July 2013

I don't have any clinical information on this ECG unfortunately.

ECG of the Week - 24th June 2013 - Interpretation

This ECG is from a 29 year old female.
She presents to your ED complaining of palpitations and an episode of chest tightness. The chest tightness lasted 45 minutes and was associated with nausea and dizziness. She has a history of pericarditis as a teenager and gives a long history of intermittent palpitations.
She was pain free when this ECG was performed with normal vital signs.

ECG of the Week - 24th June 2013

This ECG is from a 29 year old female.
She presents to your ED complaining of palpitations and an episode of chest tightness. The chest tightness lasted 45 minutes and was associated with nausea and dizziness. She has a history of pericarditis as a teenager and gives a long history of intermittent palpitations.
She was pain free when this ECG was performed with normal vital signs.

ECG of the Week - 17th June 2013 - Interpretation

This ECG is from a 62 yr old male c/o chest pain for 2 hours

ECG of the Week - 17th June 2013

This ECG is from a 62 yr old male c/o chest pain for 2 hours

ECG of the Week - 10th June 2013 - Interpretation

This ECG is from an 84 year old male.
Presents complaining of general lethargy, nausea, several episodes of diarrhea, and dizziness.
Past history of atrial fibrillation, diabetes, and hypertension.
Medications include aspirin, ACE inhibitor, statin, sulphonylurea, and digoxin.
He is conscious, vague but orientated, and his BP is 112 systolic.

ECG of the Week - 10th June 2013

This ECG is from an 84 year old male.
Presents complaining of general lethargy, nausea, several episodes of diarrhea, and dizziness.
Past history of atrial fibrillation, diabetes, and hypertension.
Medications include aspirin, ACE inhibitor, statin, sulphonylurea, and digoxin.
He is conscious, vague but orientated, and his BP is 112 systolic.

ECG of the Week - 3rd June 2013 - Interpretation

This ECG is from a male presenting with chest pain, I don't know his age so let's say mid-fifties.

ECG of the Week - 3rd June 2013

This ECG is from a male presenting with chest pain, I don't know his age so let's say mid-fifties.

ECG of the Week - 27th May 2013 - Interpretation

This rhythm strip is from a mid forties male who presented following an episode of syncope.
He complains of nausea and dizziness on arrival to the ED.
Whilst being assessed he has an episode of unresponsiveness, the rhythm strip below was taken during this period.

ECG of the Week - 27th May 2013

This rhythm strip is from a mid forties male who presented following an episode of syncope.
He complains of nausea and dizziness on arrival to the ED.
Whilst being assessed he has an episode of unresponsiveness, the rhythm strip below was taken during this period.

ECG of the Week - 20th May 2013 - Interpretation

This ECG is from a 64 year old male. 
Presented following multiple episodes of syncope.

ECG of the Week - 20th May 2013

This ECG is from a 64 year old male. 
Presented following multiple episodes of syncope.

ECG of the Week - 13th May 2013 - Interpretation

This ECG is from a 23 year old female presenting with epigastric pain.

ECG of the Week - 13th May 2013

This ECG is from a 23 year old female presenting with epigastric pain.

ECG of the Week - 6th May 2013 - Interpretation

I don't have any clinical information on this case unfortunately but it looks like an interesting ECG :-)

ECG of the Week - 6th May 2013

I don't have any clinical information on this case unfortunately but it looks like an interesting ECG :-)

ECG of the Week - 29th April 2013 - Interpretation

This ECG is from a 47 year old female presenting with palpitations of 3 hours duration.

ECG of the Week - 29th April 2013

This ECG is from a 47 year old female presenting with palpitations of 3 hours duration.

ECG of the Week - 22nd April 2013 - Interpretation

This ECG is from a 78 yr old male who presented with a 2 day history of lethargy and dizziness

He has a history of ischaemic heart disease, type 2 DM, hypertension, and chronic renal failure. 
Medications include calcium-channel blocker, beta-blocker, and ACE-inhibitor.

Conscious with systolic BP of 70 !

ECG of the Week - 22nd April 2013

This ECG is from a 78 yr old male who presented with a 2 day history of lethargy and dizziness

He has a history of ischaemic heart disease, type 2 DM, hypertension, and chronic renal failure. 
Medications include calcium-channel blocker, beta-blocker, and ACE-inhibitor.

Conscious with systolic BP of 70 !

ECG of the Week - 15th April 2013 - Interpretation

This week's ECG is from a 52 year old male.

Pt has a history of congestive cardiac failure, hypertension, hypercholesterolaemia and previous atrial flutter. 

Presented with palpitations with no chest pain or SOB when this ECG was taken.

ECG of the Week - 15th April 2013

This week's ECG is from a 52 year old male.

I will try to find out the clinical scenario regarding his presentation and will add it here if I can find it. 

UPDATE 15/04/2013

Pt has a history of congestive cardiac failure, hypertension, hypercholesterolaemia and previous atrial flutter. 

Presented with palpitations with no chest pain or SOB when this ECG was taken.

ECG of the Week - 8th April 2013 - Interpretation

This ECG is from a 52 year old male presenting with chest pain.

ECG of the Week - 8th April 2013

This ECG is from a 52 year old male presenting with chest pain.

The Wenckebach Counter-Intuition

We are going to depart a little from our usual format today and address an ECG related question we asked yesterday.

This all stem's from this week's ECG which showed a Type I 2nd Degree AV block, a.k.a Wenckebach conduction. 

ECG of the Week - 1st April 2013 - Interpretation

We didn't have any clinical information on this week's ECG, but that shouldn't stop us being able to review the ECG.

ECG of the Week - 1st April 2013

Sorry, I don't have any clinical information on this one.

ECG of the Week - 25th March 2013 - Interpretation

This ECG is from a 40 yr old male who presented following a large overdose of an anti-spasmodic agent.

ECG of the Week - 25th March 2013

This ECG is from a 40 yr old male who presented following a large overdose of an anti-spasmodic agent.

ECG of the Week - 18th March 2013 - Interpretation

For those of you at SMACC 2013 (Twitter #SMACC2013) this one will be familiar.

 

These ECGs are from a 58yr old male seen in a rural setting, approximately ~2500 km from the nearest tertiary centre.

 

He c/o intermittent atypical chest pain for several weeks without any cardiac risk factors.

At the clinic serial ECGs were performed and are below.

• What do you think of the ECGs ?
• What advice would you give assuming you were the clinician at the tertiary receiving hospital who was contacted regarding this case ?

 

ECG of the Week - 18th March 2013

For those of you at SMACC 2013 (Twitter #SMACC2013) this one will be familiar.

These ECGs are from a 58yr old male seen in a rural setting, approximately ~2500 km from the nearest tertiary centre.

He c/o intermittent atypical chest pain for several weeks without any cardiac risk factors.
At the clinic serial ECGs were performed and are below.

• What do you think of the ECGs ?
• What advice would you give assuming you were the clinician at the tertiary receiving hospital who was contacted regarding this case ?

ECG of the Week - 11th March 2013 - Interpretation

This week's ECG is from a 57 year old female.

 

I don't have any presenting complaints for this case but it is likely she would complain of weakness.

 

ECG of the Week - 11th March 2013

This week's ECG is from a 57 year old female.

I don't have any presenting complaints for this case but it is likely she would complain of weakness.

ECG of the Week - 4th March 2013 - Interpretation

Again no clinical information on this case.

 

 

 

 

ECG of the Week - 4th March 2013

Again no clinical information on this case.

ECG of the Week - 25th February 2013 - Interpretation

No clinical information on this one.

 

ECG of the Week - 25th February 2013

No clinical information on this one.

ECG of the Week - 18th February 2013 - Interpretation

Final part of the ECG trilogy.

 

The nursing staff come and get you to say the patients rhythm has changed on the monitor and they've ran off a new ECG.

 

 

ECG of the Week - 18th February 2013

Final part of the ECG trilogy.

Check out part 1 here and part 2 here.

The nursing staff come and get you to say the patient's rhythm has changed on the monitor and they've ran off a new ECG.

ECG of the Week - 11th February 2013 - Interpretation

Part two of the trilogy.

This is the next ECG in the series following on from last week's ECG.

So we've started our patient on amiodarone and this happens.

 

 

ECG of the Week - 11th February 2013

Part two of the trilogy.

This is the next ECG in the series following on from last week's ECG.

So we've started our patient on amiodarone and this happens.

ECG of the Week - 4th February 2013 - Interpretation

It's time for an ECG trilogy.

Over the next 3 weeks we have a series of ECG's from a single patient.

 

69 year old female presenting with palpitations and mild dysponea. 

Nil chest pain, no overt cardiac failure, and an acceptable blood pressure. 
History of cardiomyopathy, chronic AF, LVF, and has an ICD in-situ.

ECG of the Week - 4th February 2013

It's time for an ECG trilogy.

Over the next 3 weeks we have a series of ECG's from a single patient.

69 year old female presenting with palpitations and mild dysponea. 
Nil chest pain, no overt cardiac failure, and an acceptable blood pressure. 
History of cardiomyopathy, chronic AF, LVF, and has an ICD in-situ.

ECG of the Week - 28th January 2013 - Interpretation

This week's ECG was kindly donated by @UnaNicI. It's from a 45 year old male.

 

 

ECG of the Week - 28th January 2013

This week's ECG was kindly donated by @UnaNicI. It's from a 45 year old male.

ECG of the Week - 21st January 2013 - Interpretation

This patient, unknown age & gender, presented with chest pain & dysponea.

 

ECG of the Week - 21st January 2013

This patient, unknown age & gender, presented with chest pain & dysponea.

ECG of the Week - 14th January 2013 - Interpretation

Another week of mystery. 
 

This ECG is from a male, and that's all I've got.

ECG of the Week - 14th January 2013

Another week of mystery. 

This ECG is from a male, and that's all I've got.

ECG of the Week - 7th January 2013 - Interpretation

This is one of the older ECG's I have in my collection, and it didn't come with any clinical information, sorry.

ECG of the Week - 7th January 2013

This is one of the older ECG's I have in my collection, and it didn't come with any clinical information, sorry.

Have a look and see what you think.

ECG of the Week - 31st December - Interpretation

A bit of a departure from the normal to herald in the New Year.

 

This week we have a rhythm strip I found.

 

I don't have any information on the case, patient, or management.

 

So what you see is what you get !