زكاة العلم الدكتور محمد البيضاني

24 years old male with negative past medical history presented to the emergency department of AL Majar Al kabeer hospital with apnea, no carotid pulsation and asystole on monitor due to electrical shock. I start CPR and resuscitation with Dr. Mulhim and other medical staff. Anyhow after 4-5 cycle I l feel pericardial pulsation, Doctors Mulhim check the heart with the monitor and the patient was sinus rhythm and the patient start breathing (gasping breath). Rapidly I did endotracheal tube and call the Alsader teaching hospital to prepare bed in the ICU to put the patient on mechanical ventilation the distance from my hospital to the centre is 35 km . I went with patient by ambulance with manual breathing by ambo bag . Then the patient reach to the ICU and complete the treatment. Now the patient extubated and power and tone is very good , start oral intake and walk. but there is slight confusional state which is reversible. These photos numbered according to the series events الحمدلله حتى يبلغ الحمد منتهاه

Digoxin effect refers to the presence on the ECG of: • Downsloping ST depression with a characteristic “reverse tick” or “Salvador Dali sagging” appearance • Flattened, inverted, or biphasic T waves • Shortened QT interval Additional ECG Features • Mild PR interval prolongation, up to 240 ms (due to increased vagal tone) • Prominent U waves • Peaking of the terminal portion of the T waves • J point depression (usually in leads with tall R waves) Conclusion: digoxin effect not related to digoxin toxicity and digoxin effects may occur from first dose😛.

ECG of 18 years old female show T wave inversion in right pericardial leads (V1,2,3) This is normal. Sometimes these changes persist up to 45 years old and define as persistent juvenile T wave inversion.

60 years old male with history of congestive heart failure presented with paroxysmal attack of palpitations. ECG show - paroxysmal attack of wide complex tachycardia, regular and not preceded by P wave - if you look carefully to the beat number 6 in lead I it appears narrow and preceded by P wave This is non sustained VT . You should treat the underlying causes in this patient there is LV dysfunction and Ischmic myopathy so we can give amidarone accordingly.

ECG 1,2 show - bradycardia - AV dissociation - regular P -P interval and at rate higher than ventricular - regular R-R interval and QRS take shape of LBBB. ( escape rhythm) So this is complete heart block ECG 3 show - regular - wide QRS and take shape of LBBB - spike before QRS This is right ventricular pacemaker of patient with ECG1,2

ECG 1,2 show - bradycardia - AV dissociation - regular P -P interval and at rate higher than ventricular - regular R-R interval, narrow ( junctional escape rhythm) So this is complete heart block. ECG 3 show - regular - wide QRS and take shape of LBBBBL - spike before QRS This is right ventricular pacemaker of patient with ECG1,2

What is the ECG findings of this case ?

30 years old male with negative past medical history of chronic disease , non smoker presented to the emergency department with nausea and vomiting 3 times . The feature appears during football match .there is no history of chest pain or tightness or SOB . ECG show anteriolateral MI due to occlusion of beginning of left anterior descending coronary artery (LAD). Primary PCI was done ✅ Gues what is the message from the case?

24 years old females with congenital heart disease and pulmonary hypertension Rough assessment of the ECG - right axis deviation ( negative R in lead I and positive R in avF) - prominent R wave in right pericardial leads (V1,2,3 ) - rsR pattern in V2 with narrow QRS ( partial RBBB) - T wave inversion and fattening of T wave in V1,2 - persistent deep S in V6. These features of right side strain pattern and Right ventricular hypertrophy. Echo show dilation of right ventricular with hypertrophy and flattening of intraventricular septa with D shape of left ventricular

24 years old females with congenital heart disease and pulmonary hypertension Rough assessment of the ECG - right axis deviation ( negative R in lead I and positive R in avF) - prominent R wave in right pericardial leads (V1,2,3 ) - rsR pattern in V2 with narrow QRS ( partial RBBB) - T wave inversion and fattening of T wave in V1,2 - persistent deep S in V6. These features of right side strain pattern and Right ventricular hypertrophy.

As simple as that during taking history Mumm did you had an occluded vessel? Yes my sun I had three vessel disease 🥹

40 years old male heavy smoker presented with chest pain since 24h. ECG show - ST change preceded by Q wave in V1,2,3,4 - poor progression of R and wave Troponine titter Echo study show : apical akinesia and anterioseptal sever hypokinesia Conclusion: ST change with Q wave indicate stablished anteriosptal MI Which documented by echo and Troponine Notes - akinesia mean no muscle contraction and hypokinesia decrease in the contractility - established MI mean the patient pass the golden period for reperfusion therapy - one of the causes of poor progression of R wave in pericardial lead is old anterior MI - poor progression of R wave mean shifting of transition of R wave > S wave beyond V4.

60 years old male with history of HTN, DM and heavy smoker. Presented with severe chest pain for 5 hours then with the time he become agitated, irritable, sweaty , palar and cold extremities . Chest examination revealed mild chest crepitation. Vital signs BP:80/60mmHg Spo2: 90% random blood sugar 300 mg/dl. ECG show - widespread ST depression ( lead I,II,avF and pericardial lead ) the clinical features and echo study show patients in cardiogenic shock. And the ECG gives three differential diagnosis ( differential diagnosis of widespread ST depression and ST elevation in avR) - three vessels disease - left main stem coronary artery occlusion - proximal left anterior descending coronary artery occlusion I this this is left main stem occlusion. Unfortunately the patient died as the mortality rate of cardogenic shock is high And if you diagnosed cardiogenic shock and patient alive change you mind.

اول تعليق

60 years old female presented with SOB, dyspneic ,tachypneic, pale , sweaty and confusion. BP:80/60mmHg Spo2: 90 ECG show - right axis deviation - pattern of RBBB with prominent of R wave in V1,2,3 ( right ventricular hypertrophy) - poor progression of R wave in pericardial lateral with persistent S wave in V6 and S T depression in inferior leads due to pressure overload on the right side . Echo study show Dilated Right side with sever pulmonary hypertension. CT angiography show filling defects in the pulmonary branches . Conclusion: pulmonary embolism.

Old age male with complete heart block and Perminant pacemaker - spike befor QRS - features of LBBB as the pacemaker implanted in the right ventricular If the patient develop chest pain you can use sgarbosa criteria as for LBBB to detect new ischmia