Dr Marwah,s Ecg Blog

15/08/2021

2nd Ecg Blog posted
TachyCardia Aflutter but what’s the end

A middle-aged patient was sent to the ED with tachycardia. He denied any sensation of palpitations, but his heart rate was consistently 150 bpm. The other vitals were normal. He had JVD and swollen legs, but clear lungs and a normal room air oxygen saturation.

He denied all typical and atypical ischemic symptoms. He noted, however, that he had had marked fatigue starting about 5 days ago, but that he was actually feeling much better today
Ecg below shows The rhythm appeared to be atrial flutter, but also concerning were the ST segment elevations in I, aVL, V2, and V3, as well as ST depression in the reciprocal inferior leads.

But atrial flutter can alter the baseline such that there is only apparent STE or ST

The physician's thoughts=(Mine thought as I am on ED): This pattern is concerning for anterior wall OMI, specifically a proximal LAD lesion. There are Q waves in V1-V3, suggesting an old anterior MI, but the T waves in V2 and V3 are fairly tall, suggesting some degree of acute ischemia. Also, there are no T wave inversions which would suggest a subacute, evolved, or reperfused MI.

The patient, with an easy smile, again denied any symptoms.

Atrial flutter can mimic the ECG signs of an MI
So I activate the Cath lab and boom
Patient has Occuloded left Anterior Artery &Trops are highly elevated

Diagnosis ends on Myocardial Infaraction

15/08/2021

A middle-aged patient was sent to the ED with tachycardia. He denied any sensation of palpitations, but his heart rate was consistently 150 bpm. The other vitals were normal. He had JVD and swollen legs, but clear lungs and a normal room air oxygen saturation.

He denied all typical and atypical ischemic symptoms. He noted, however, that he had had marked fatigue starting about 5 days ago, but that he was actually feeling much better today
Ecg below shows The rhythm appeared to be atrial flutter, but also concerning were the ST segment elevations in I, aVL, V2, and V3, as well as ST depression in the reciprocal inferior leads.

But atrial flutter can alter the baseline such that there is only apparent STE or ST

The physician's thoughts=(Mine thought as I am on ED): This pattern is concerning for anterior wall OMI, specifically a proximal LAD lesion. There are Q waves in V1-V3, suggesting an old anterior MI, but the T waves in V2 and V3 are fairly tall, suggesting some degree of acute ischemia. Also, there are no T wave inversions which would suggest a subacute, evolved, or reperfused MI.

The patient, with an easy smile, again denied any symptoms.

Atrial flutter can mimic the ECG signs of an MI
So I activate the Cath lab and boom
Patient has Occuloded left Anterior Artery &Trops are highly elevated

Diagnosis ends on Myocardial Infaraction

12/08/2021

Here is my first EKG Blog

Patient of 50 years old Came to emergency with Epi gastric pain Here is the ecg
My interpetion

There is a saddleback, which is rarely due to MI. V2 has the morphology of type II Brugada, as there is a relatively large beta a However, whenever you see an rSR', especially with a saddleback, think of lead placement.

Then look at the P-wave in V2. Is it fully upright? If not, then there is probable high placement of lead V2.

I went back to look and, indeed, V1 and V2 were placed too high.

I put them in the correct position and we recorded another ECG:
You can use the LAD-Early Repol Formula to differentiate this from LAD occlusion:

ST elevation at 60 ms after the J-point, relative to PQ junction (STE60V3), = 2.5mm
QTc by computer = 384
R-wave amplitude in V4 (RAV4) = 19mm
Total QRS amplitude in V2 (QRSV2) = 17.5mm Value come to be 17.445 which is quite normal
Learning Points
1. Saddleback ST Elevation is almost never STEMI
2. Saddleback STE may be type II Brugada syndrome
3. A Type II mimic may result from leads V1 and V2 placed too high
4. An inverted P-wave in lead V2 implies lead misplacement too high

On Negative Trops pt is discharged
And finally diagnosed with GERD

12/08/2021

Patient of 50 years old Came to emergency with Epi gastric pain Here is the ecg
My interpetion

There is a saddleback, which is rarely due to MI. V2 has the morphology of type II Brugada, as there is a relatively large beta a However, whenever you see an rSR', especially with a saddleback, think of lead placement.

Then look at the P-wave in V2. Is it fully upright? If not, then there is probable high placement of lead V2.

I went back to look and, indeed, V1 and V2 were placed too high.

I put them in the correct position and we recorded another ECG:
You can use the LAD-Early Repol Formula to differentiate this from LAD occlusion:

ST elevation at 60 ms after the J-point, relative to PQ junction (STE60V3), = 2.5mm
QTc by computer = 384
R-wave amplitude in V4 (RAV4) = 19mm
Total QRS amplitude in V2 (QRSV2) = 17.5mm Value come to be 17.445 which is quite normal
Learning Points
1. Saddleback ST Elevation is almost never STEMI
2. Saddleback STE may be type II Brugada syndrome
3. A Type II mimic may result from leads V1 and V2 placed too high
4. An inverted P-wave in lead V2 implies lead misplacement too high

On Negative Trops pt is discharged
And finally diagnosed with GERD

12/08/2021