Q+A ECGs for SMACC 2014

The following ECGs were submitted by participants for discussion at the SMACC Gold ECG Workshop 2014.

ECG 1

64-year old with severe central chest pain and diaphoresis.

AC 1

Thanks to Andrew Coggins for sharing this ECG.

 

 

ECG series 2

Middle aged female presenting with chest pain, nausea and diaphoresis.

“There are six ECGs taken over a 44 minute period of a middle aged female pt with no PHx, that presented with CP, diaphoresis and nausea/vomiting. Pt went into VF and reverted with 1x DCCS prior to 12-lead being performed. Initial 3 lead taken showed hyperacute T waves in Lead I, with STD in Leads II and III.

ECGs 1, 3 and 4 were taken with the pt experiencing CP, diaphoresis, nausea and vomiting with ECGs 2, 5 and 6 being taken when the pt had <1/10 pain and resolution of her diaphoresis and nausea.

The pt was taken to Cath Lab ~10/60 after having the last ECG taken. Whilst moving onto the table, her symptoms returned with associated elevation of her ST segments. 5/60 later, the pt had a VF arrest which didn’t respond to DCCS attempts. Pt was placed on the LUCAS device and her proximal LAD was stented with ROSC after ~40/60. Pt had a full neurological recovery. ”

(i) Chest pain and diaphoresis

ECG1 T=0

(ii) Temporary resolution of pain

ECG2 T=20mins

(iii) Recurrence of pain

ECG3 T=25mins

(iv) Ongoing ischaemic symptoms

ECG4 T=35mins

(v) Symptoms improving

ECG5 T=38mins

(vi) Minimal symptoms

ECG6 T=44mins

Thanks to Andrew Bishop for sharing this ECG series.

 

ECG 3

28-year old patient presenting with syncope. Examination and vital signs unremarkable.

VS ECG1

Thanks to Victoria Stephen for sharing this ECG.

 

ECG 4

37-year old man with atypical chest pain.

  • Normally healthy 37-year old male.
  • Presented with pressure-like retrosternal chest pain, gradually worsening severity over 1 hour period.
  • Atypical in character — i.e. non-pleuritic, exacerbated with leaning forward, relieved by laying supine. No diaphoresis, nausea, vomiting. No radiation.
  • Had used sildenafil in the preceding 24 hours. No other drugs / medications / precipitants.
  • Physical exam unremarkable. BP 130/90, P 86. Sats 96% RA.
  • No changes on serial ECGs (this is the second ECG in the series, taken at ~5h post onset of pain).
  • This case was a difficult call as no cardiology cover / PCI available overnight — confirmed STEMI would have required thrombolysis.
  • Possibilities considered by the treating doctors included extensive STEMI, pericarditis and coronary artery spasm.

VS 2

Thanks to Victoria Stephen for sharing this ECG.

 

ECG 5

94-year old patient with palpitations.

  • Presented with 1/52 Hx of intermittent palpitations, nausea, weakness and presyncope
  • Discharged from hospital 1/52 prior following an admission for palpitations/rapid AF;   discharged with an increased verapamil dose.
  • Background Hx of PPM for AF (?tachy brady), hypothyroidism, and HTN.
  • Meds = warfarin, sotalol, verapamil, thyroxine, ISMN, digoxin.
  • Asymptomatic at time of ECG recording.

KK 1

Thanks to Ken Ku for sharing this ECG.

 

 

ECG 6

37 y/o male with chest pain. Clinically stable. Pain settled with aspirin + GTN. No cardiac risk factors.

MW1

Thanks to Michelle Withers for sharing this ECG.

 

 

ECG 7

14-year old girl. PEA/asystolic arrest following drowning. Achieved ROSC post CPR + 5mg adrenaline.  Profoundly acidotic on arrival to ED (pH 6.3).

Resus ECG 1 Resus ECG 2 Resus ECG 3 Resus ECG 4

Thanks to Brian Ch’ng for sharing these ECGs.

 

 

ECG 8

44-year old male, presented to ED by ambulance feeling generally unwell. Intoxicated with alcohol.

BC 3

Thanks to Brian Ch’ng for sharing this ECG.

 

 

ECG 9

30-year old, palpitations and syncope

Hypokalaemia-torsades

 

 

ECG 10

70 yo, generalised weakness

ECG 12

 

 

ECG 11

Chest pain, now resolved

ECG 14

14b

 

 

ECG 12

80-year old with collapse

ECG 8

Thanks to Salem Rezaie for sharing this ECG.

 

 

ECG 13

Chest pain.

ECG 9

Thanks to Salem Rezaie for sharing this ECG.

 

 

ECG 14

Chest pain.

ECG 10

Thanks to Salem Rezaie for sharing this ECG.

 

 

ECG 15

Chest pain.

ECG 11

Thanks to Salem Rezaie for sharing this ECG.

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