EKG Case Studies
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Case 1: 54 year old man with a heart transplant: The EKG shows: Sinus rhythm
with a right bundle branch block and a left
anterior hemiblock. Also there is a left atrial
abnormality
and
independent atrial activity.
Case 2: A 70 year old man with
supraventricular
tachycardia
for years. The first tracing was then while the patient was in the
hospital
and was recorded via telemetry. This is the initiation of spontaneous
A/V
nodal reentry tachycardia (AVNRT).
The second tracing was recorded in the electrophysiology laboratory and
shows the
initiation of AVNRT with ventricular
stimulation. Compare this to the spontaneous event.
The third tracing was recorded in the electrophysiology laboratory and
shows
termination
of the AVNRT with ventricular pacing.
One way of determining if a supraventricular arrhythmia is AVNRT is to
compare
the depolarization sequence of the left atrium from a coronary sinus
recording
. The left
atrium depolarizes from the area
of the AV node to the distal CS both in sinus rhythm
and AVNRT
tachycardia.
Case 3: (October 96 puzzler) An 65 year old woman with tiredness and
difficulty
walking. The EKG shows
complete
heart block.
Case 4: A 70 year old woman with recurrent ventricular tachycardia and a
severe
intra-ventricular
conduction defect.
Case 5:A
62 year old man with a severe intra-ventricular
conduction defect simulating ventricular bigemini.
Case 6:
A tracing from an 80 year old man post
aortic valve replacement. The recording is from his implanted pacemaker
showing an atrial tachycardia. The tracing also illustrates the magnet
response
of this pacemaker.
Case 7:
A
12 lead EKG from a 72 year old man with
supraventricular tachycardia with 2:1 block. This patient had chest pain
on walking that was probably due to 1:1 conduction of his tachycardia.
Case 8: A series of electrocardiograms from a 78 year old woman who was
implanted with a pacemaker in 1991. The patient developed congestive
heart
failure five years later due to
pacemaker
syndrome
which was corrected by switching to atrial pacing.
Case 9:An
electrocardiogram from a patient
with a cardiac myoplasty stimulator.
Case 10:
EKG
with suppression of an implanted
pacemaker with an external pacemaker.
Case 11:
A
wide complex tachycardia (atrial flutter
with 1:1 conduction) in a patient with corrected Tetralogy of Fallot.
Recorded
with a loop monitor.
Case 12:
A case of tachy-brady syndrome. The
recording is from a loop recorder and shows atrial flutter followed by
asystole.
Case 13:
A patient with a RBBB and PACs.
Case 14:
A
problem with atrial capture with a
dual chamber pacemaker with a long A/V interval.
Case
15: A patient with MobitzII A/V block
post pacemaker implant for syncope
Case 16:
A patient with an atrial pacer that
did not seem to pace properly.
Case 17
:
A "routine" telephone pacemaker
check!!
Case 18: An EKG strip from a patient with a rate responsive pacer with a respiratory sensor.
Case 19: Puzzler (March 97) ECG strip and images from a patient post DDD pacemaker implant.
Case 20: An ECG from a patient with Torsade de Pointes ventricular tachycardia in the surgical recovery room.
Case 21: A series of ECGs from a patient with severe hyperkalemia, in the emergency room
Case 22: Puzzler to be (1997). A telephone strip from a patient in the high aortic
Case 23: A patient on the hospital ward with RBBB, Left Posterior Hemiblock.
Case 24: A patient with recurrent wide complex tachycardia and previous inferior and true posterior myocardial infarction.
Case 25: A patient in the out-patient clinic with left ventricular hypertrophy and strain
Case 26: A patient in the out-patient clinic with an anterior myocardial infarction.
Case 27: A patient in the hospital with atrial flutter and a slow ventricular response.
Case 28: Two ECGs from a patient in an emergency room, first with venticular tachycardia and then after a shock, sinus rhythm.
Case 29: Three ECGs and X-ray from a patient with syncope and chest pain. The EKGs show nodal rhythm, pericarditis and the X-ray shows perforation of the temporary wire into the pericardial space.
Case 30: Puzzler (1997). An EKG from a man post coronary bypass with syncope due to ventricular tachycardia.
Case 31: Lateral wall myocardial infarction
Case 32: Ventricular Pre-excitation
Case 33: Alternating bundle branch block, accelerated junctional rhythm
Case 34: Sinus rhythm with left and possibly right atrial abnormality also the same patient in atrial fibrillation
Case 35: Sinus rhythm with and without a right bundle branch block
Case 36: Paced atrial rhythm in an elderly patient with right ventricular tachycardia who is being treated with flecainide
Case 37: Sinus arrest and junctional escape.
Case 38: Ventricular paced rhythm with atrial flutter
Case 39: Sinus rhythm with right bundle branch block and a sinus pause with which discloses a rate dependent left anterior hemiblock
Case 40: Sinus rhythm with RBBB in a middle aged man with recurrent atrial fibrillation
Case 41: an elderly man recurrent ventricular tachycardia and previous inferior myocardial infarction, EKG shows sinus rhythm RBBB, right axis deviation, inferior Q waves and PVCs
Case 42:a middle aged man with recurrent ventricular tachycardia and previous myocardial infarctions and coronary artery bypass. The EKG shows inferior as well as antero-lateral q waves as well as first degree A/V block.
Case 43:an older woman with previous anterior wall myocardial infarction with q waves in the anterior precordial leads
Case 44: an elderly man, post cardiac arrest, with previous inferior wall myocardial infarction with intermittent complete heart block congestive failure and a first degree A/V block with left atrial abnormality and intraventricular conduction defect
Case 45: a middle aged man with recurrent atrial fibrillation and syncope treated with an atrial pacemaker. The EKG shows paced atrial rhythm.
Case 46: a middle aged man with previous inferior myocardial infarction. The EKG shows inferior Q waves with sinus rhythm left atrial abnormality and right bundle branch block.
A series of 5 EKGs from one patient:
Case 47: A man with a possible bradycardia dependent left bundle branch block possibly sinus rhythm with LBBB and nodal prematures that conduct without the LBBB to the ventricle and not retrograde to the atrium
Case 48: with possible accelerated junctional rhythm and LBBB or possible an accelerated venticular rhythm
Case 49: sinus rhythm and narrow complex QRS with LVH and strain
Case 50:sinus rhythm with left anterior hemi-block and anterior ST elevation of anterior wall injury
Case 51: Sinus rhythm with voltage criteria for LVH and ST abnormalities
Two EKGs from the same patient
Case 52: Sinus rhythm with PACs in trigemini and inferior q waves with t inversion of inferior myocardial infarction
Case 53: Sinus rhythm with PACs in trigemini and inferior q waves with t inversion of inferior myocardial infarction now with right bundle branch block
Case 54: A man with sinus rhythm and anterior and lateral myocardial infarctions, possibly acute.
Case 55: A patient with sinus bradycardia and one PVC, right bundle branch block and left anterior hemi-block an previous anterior wall myocardial infarction.
Case 56: A man with an acute anterior lateral myocardial infarction.
Case 57: A man with sinus tachycardia right bundle branch block, left anterior hemiblock and previous inferior wall myocardial infarction.
Case 58: A man with sinus rhythm with one PVC, and inferior and probable remote true posterior myocardial infarction.
Case 59: A middle aged man with sinus rhythm, first degree A/V block and previous inferior and anterior wall myocarial infarctions.
Case 59: A middle aged man with a remote anterior wall myocardial infarction.
Case 60: A 76 year old man with sinus rhythm with PACS, left anterior hemi block and an acute anterior/lateral myocardial infarction
Case 61: A 85 year old woman with a previous possibly acute antero/lateral myocardial infarction.
Case 62: A man with previous Anterior/lateral wall myocardial infarction.
Case 63: A woman with sinus rhythm, a right bundle branch block and inferior myocardial infarction, possibly acute.
A series of EKGs from one patient
Case 64: A patient with an acute anterior wall myocardial infarction and runs of ventricular rhythm with a RBBB morphology
Case 65: A patient with an acute anterior wall myocardial infarction and runs of competing non-sinus rhythm with a LAHB morphology
Case 66: A patient with and acute anterior wall myocardial infarction after thrombolysis.
Case 67: A middle aged man with palpitations and with a left lateral AV pathway
Case 68: A man with a previous inferior wall myocardial infarction
Case 69: An 80 year old man, with first degree A/V block and left anterior hemiblock. The first degree is revealed by a PVC
Case 70: Defibrillation threshold testing for an implantable defibrillator (successful) followed by venticular paced rhythm.
Case 71: Defibrillation threshold testing for an implantable defibrillator (successful) followed by sinus rhythm.
Case 72: A tracing from a patient with Mobitz I AV block where the AV conduction stops with VDD pacing even with a long sensed to paced interval of 300ms.
Case 73: A continuous recording of a patient being cardioverted for slow atrial flutter. Two shocks are required.
Case 74: These are tracings from a patient with a VVI.R pacer implanted on his left side and a DDD pacemaker implanted on the right.
Case 75: A 12 lead EKG from an elderly man with atrial flutter post A/V nodal ablation and implantation of a venticular pacemaker.
Case 76: Two rhythm strips from a patient with an AAI.R pacemaker with atrial sensing of the QRS due to a prolonged PR interval.
Case 77: A 12 lead EKG from a patient with a DDD pacemaker and atrial flutter/fibrillation. The pacemaker is at its upper rate limit.
Failure to sense or a recording aritfact? This is a recording from a patient with a Medtronic implantable defibrillator which also functions as a VVI pacemaker.