Elderly with Paced Rhythm, Possible Ischemic symptoms, and an Equivocal Smith Modified Sgarbossa ECG
This ECG is from a woman in her 80s who presented with a couple of days of shortness of breath, weakness and diaphoresis.
This ECG shows ventricular paced rhythm with concordant ST elevation V5-6 and concordant ST depression in V3. The cause was an occlusion of the circumflex.
Can you see through this paced rhythm?
This ECG is from an elderly woman who presented with 2 hours of chest pain on a background of multiple stents, a pacemaker, stroke and COPD.
This ECG shows paced rhythm with excessively discordant ST segments (modified Sgarbossa positive). The cause was a 95% thrombotic lesion of the RCA.
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.
This ECG is from an elderly woman who presented with chest pain on a background of a normal angiogram 3 months prior.
This ECG shows ventricular paced rhythm (likely biventricular) with concordant ST depression in III, aVF and V3. There is excessive discordant ST elevation in I and aVL. The cause was an acute left main occlusion due to suspected embolism.
See what happens when one fails to diagnose STEMI in LBBB and Paced Rhythm
This ECG is from a female in her 60s presented with 2-3 days of fatigue and shortness of breath. She called EMS when her symptoms acutely worsened while she was shopping. EMS arrived and recorded a heart rate of 27. On arrival to the ED she was noted to be in complete heart block. She was given atropine with transient increase in HR to 80s. This ECG was recorded after atropine.
This ECG shows sinus rhythm with second degree type 1 AV block and LBBB. Concordant ST elevation in III and aVF and concordant ST depression in V2. The cause was an occluded proximal right coronary artery. This was missed and the patient died.
Inferior Wall M.I. With Wide QRS and Complete AV Block
This ECG is from a woman in her 60s who presented with chest pain, nausea, vomiting and diarrhoea for 4 hours.
This ECG shows complete heart block with most likely junctional escape and LBBB. Excessive discordant ST elevation in inferior leads and concordant ST depression in V2. The cause was an acute inferior MI.
ECG of the Week – 5th January 2015 – Interpretation
This ECG is from a man in his 70s with severe dilated cardiomyopathy who presented with worsening peripheral oedema, anorexia and weakness. There was no chest pain or acute dyspnoea.
This ECG shows A-V sequential pacing with appropriate discordant ST segments apart from concordant ST depression in V3. This was not dynamic and there was no further evidence of infarction. He was most likely just generally deconditioned due to his cardiomyopathy and needed medication review.
CHF Exacerbation with Old LBBB: Is There New Infarction or Not?
This ECG is from a very elderly woman who presented with shortness of breath, chest and back pain intermittently for several nights. It was relieved by isosorbide, but when she lost this medication she became worse. She had a background of CAD, ischemic cardiomyopathy and heart failure with an ICD in situ for primary prevention. On arrival she was hypoxic (SpO2 88%) with a good BP and HR 90, but improved on CPAP then BIPAP. This was her initial ECG.