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ECG QUIZClassic Tracings for Family Physicians
Dr. Mathieu Walker
Associate Professor of Medicine, McGill University
Cardiology Divisional Director, Saint Mary’s Hospital
November 26th, 2018
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Session Objectives
1. To help you recognize some classic ECG patterns
2. To review an approach to SVT diagnosis
3. To introduce/review the Modified Valsalva maneuver
4. To teach you some of my favorite “ECG pearls”
5. For you to have some fun and test your ECG interpretation
skills!
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The presentation slides in their entirety will be posted after
the
lecture
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Narrow complex tachycardia – Specific Dx?
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Match each figure on the left with the arrhythmia on the
right
1. Atrial fibrillation2. Multifocal atrial
tachycardia (MAT)3. AV node reentry
tachycardia (AVNRT)4. Atrioventricular reentry
tachycardia - AVRT (orthodromic)
5. Atrioventricular reentry tachycardia-AVRT (antidromic)
6. Atrial flutter7. Atrial tachycardia
N Engl J Med 2012;
367:1438-1448
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Another SVT case: Can you see P waves?
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Identify the rhythm
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Explain the change in QRS morphology halfway through the
tracing
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Explain the change in QRS morphology
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Diagnosis? Treatment in the symptomatic pt?
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Grouped Beating
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Does this patient have evidence of an old myocardial
infarction?Why is the 5th QRS complex different?
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What is the rhythm?
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What arrhythmia is this patient at risk for developing?
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You are presented with this rhythm strip in the E.D. What is
your immediate management?
Rhythm strip
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Rhythm?
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What rhythm is shown? Treatment?
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. Sinus tachycardia . Low voltage, extremity and precordial
leads . Nonspecific T abnormalities, lateral leads
918559 26-Mar-2010 10:55:33GROS , MONICA
DOB: 24-Feb-1962 48 Years Female Dept: ER
4Room:
Oper: MN
HR 124
PR 122
QRSD 58
QT 298
QTc 428
-- AXIS --
P 27
QRS 74
Requested By: DRUMMOND, D.
Patient Code:OUT
Standard 12- ABNORMAL ECG -
CONFIRMED BY : Derek Marpole, M.D. 26-Mar-2010 14:02:50SMHC -
Main Campus (100-10000-07)
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
II
Chest: 10 mm/mVLimb: 10 mm/mVSpeed: 25 mm/secDevice: BME 04838 F
60~ 0.5-40 Hz W PH100B L P?
65 year old woman with metastatic breast cancer.
Hypotensive.Most likely diagnosis?
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Identify the rhythm
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58M with retrosternal chest pain.What is the most likely
diagnosis?
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Which cardiac chamber is abnormal in this patient?
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What is the rhythm? What is the cause? What treatment do you
recommend?
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What electrolyte abnormality is present?
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Worsening electrolyte abnormality
