زكاة العلم الدكتور محمد البيضاني

Anteriolateral MI with sever LV systolic dysfunction in echo study.

Old age male negative history of IHD but He was DM , HTN and heavy smoker. Presented with chest , he report frequent attacks of this pain previous The pain was mild and ECG show - irregular and No P wave >>> AF - there is biphasic T wave in V3 and T wave inversion in lateral leads which is specific for left anterior descending coronary. Echo study show anterior and septal hypokinesia which support the ECG interpretation The patient had critical lesion in LAD artery And need urgent PCI.

Old age male with history of IHD presented with palpitations ECG show sinus rhythm with frequent ventricular ectopic beats monomorphic type and appear couplet at some area ( double ventricular ectopic beats) .

Sinus rhythm with supranodal ectopic beats - come early - not preceded by P wave - post ectopic pause ( wide distance) - has shape similar to the preceded beat)

Young age male with family history of sudden death developed syncope and sudden cardiac arrest during praying in the hospital fortunately. Resuscitation was done perfectly and was heart get functioning. The ECG after resuscition show - pattern of RBBB in V1 - ST elevation V1,2 - downsloping T wave inversion in V1 So this ECG of patient with sudden cardiac arrest and positive family history of sudden death put brugada at the top of differential diagnosis. The brugada then confirmed and intracardiac defibrillator was implanted later on

Left anterior fascicular block Criteria - left axis deviation ( positive R in lead I and negative R in avF) - small Q and large R either in lead I or avL Plus small R and deep S of j either lead III or avF.

Left anterior fascicular block Criteria - left axis deviation ( positive R in lead I and negative R in avL) - small Q and large R either in lead I or avL Plus small R and deep S of j either lead III or avF.

Old age female admitted to the hospital due to chest infection. He had history of HTN and DM. ECG (1) show : sinus rhythm with RBBB. Then in the hospital the patient becomes unwell and develope vomiting , nausea and confusion the ECG (2) show - RBBB - complete heart block with junctional escape rhythm ( regular, narrow QRS , atrial rate about 80 bpm and ventricular rate 40 , irregular PR interval and no relationship between atrium and ventricular) Senior cardiologist did pacemaker as appear in ECG (3) - regular - wide qrs and take the shape of LBBB as the pacemaker in the right ventricular ( electricity pass from the right to left similar to those with LBBB) - there is spike befoe QRS which related to paces.

Young age with heavy smoking presented with typical chest pain , nausea , paler, sweating, the pain radiate to left shoulder and back. previous ECG didn’t show RBBB The new ECG has - RBBB ( rSR pattern in V1) - left anterior fascicular black 1- left axis deviation ( positive R in lead I and negative R in lead AvF) 2- small q and large R in lead I plus small r and deep S in avF Typical chest pain, risky patient of IHD , new RBBB and left axis deviation this is related to occlusion of left anterior descending coronary artery and more dangerous than LBBB . The patient will not has ST change And the only ECG finding is RBBB and fascicular block. My message: respect chest pain in patient with RBBB.

Did you hear about high lateral MI. ECG features: - ST elevation primarily localised to leads I, aVL +/- V2 - Reciprocal ST depression and/or T wave inversion in inferior leads, most pronounced in lead III Blood vessels - Occlusion of the first diagonal branch (D1) of the left anterior descending artery (LAD) may produce isolated ST elevation in I and aVL - Occlusion of the left circumflex artery may cause ST elevation in I, aVL along with leads V5-6. South African Flag sign High lateral STEMI is associated with a pattern of ST elevation caused by acute occlusion of the first diagonal branch of the left anterior descending coronary artery (LAD-D1). • ST Elevation: Lead I, aVL, V2 • ST Depression: Lead III (and inferior leads)

Old age male with history of IHD and frequent attacks of palpitations presented to the ED with palpitations . He reported similar attacks of palpitations that relived by IV medical. ECG (1) - regular - no P wave - slightly Wide QRS - the R wave in pericardial lead had normal progression ( not all above or all down as in VT) - features of LBBB in lead I and avL ( slightly wide QRS with T wave inversion) and discordant ST elevation in V1,2,3 This is SVT with LBBB Patient take IV adenosine and get well The ECG (2) show sinus rhythm with LBBB.

Old age male with history of IHD and frequent attacks of palpitations presented to the ED with palpitations . He reported similar attacks of palpitations that relived by IV medical. ECG (1) - regular - no P wave - slightly Wide QRS - the R wave in pericardial lead had normal progression ( not all above or all down as in VT) - features of LBBB in lead I and avL ( slightly wide QRS with T wave inversion) and discordant ST elevation in V1,2,3 This is SVT with LBBB Patient take IV adenosine and get well The ECG (2) show sinus rhythm with LBBB.

#serial ECG Young age Frequent attacks of chest pain ECG (1). Show - non specific st depression inferior leads - biphasic T wave in pericardial lead particularly V2 ECG (2) ST elevation of n anteriolateral leads with reciprocal ST depression in inferior leads .

Case 17 60 years old male obese, DM, HTN, smoker with history of IHD and previous PCI come to hospital with epigastric pain after heavy meals, nausea and vomiting. Examination revel no significant findings. The patient had history IBS and GARD on omeprazole as he said. S troponine and electrolytes was normal Vital signs was normal ECG was done Is there anything significant findings in the ECG, interpret the findings?

Don’t give DC should if patient don’t need ( some doctor give the shock to show the relatives as they try to resuscitate the patient) Don’t learn the principles of DC shock on dead patients This picture related to my friend dr Ali alwaily.

40 years old male smoker with negative past medical history presented with chest pain as you see in ECG (1) which show T wave inversion in lead I and avL and non specific changes in pericardial leads. Then after one hour the pain become sever with new changes in ECG (2) - beginning of ST elevation in lead and avL with ST depression and T wave inversion in lead III and VF - hyperacute T wave , with narrow base in pericardial leads Patient get VF after few minutes from the ECG(2) and not responded to resuscitation. My message - respect the chest pain at all - respect the minimal ECG changes in patient without history of IHD but had risk factor - disrespect the decision of Senior resident when they disrespect the chest pain and neglect the critical case. And try to keep the patient under observation as much as possible - these simple treatment (aspirin, clopidogrel, heparin beta blocker and so one ) may open the vessel partial So respect them - respect your job and your self and consult your partner

Chest pain

50 years old female with history of operation before one day, presented with SOB , dyspneic , tachypneic, pale, sweaty , agitation , clear chest, good air entry .vital signs Blood pressure low , Spo2 low and tachycardia ECG - sinus tachycardia - slightly S1 Q3T3 - persistent deep S in V6 ( poor progression of R wave in pericardial leads) due to right side overload. Unfortunately patient was dead.

اقرا اول تعليق احد كيسات الكتاب