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2. Case 1
57 year old gentleman presents to the Emergency Department at Gold Coast Hospital with
Shortness of breath
Chest pain

3. What further questions from the history would you ask?

4. History
He has a background history of hypertension, dyslipidemia and diabetes mellitus
The chest pain was substernal and radiated to his left arm.
Associated with diaphoresis and shortness of breath. He has vomited twice and now is intermittently feeling lightheaded.

5. What would you look for in the clinical examination?

6. His temperature is 37.4, heart rate 70, blood pressure 110/70, and respiratory rate 24.
His physical exam shows mild bilateral crackles on lung exam
His heart sounds are regularly irregular, and an S4 heart sound is present.

7. What Investigations would you order

9. Other Investigations??

10. Management

11. Case 2
A 91 year old male with no significant past medical history presents
with generalized weakness
one episode of syncope while sitting down to dinner.

12. What further history would you ask?

13. What findings would you look for in the clinical examination?

14. His blood pressure is 132/58, heart rate 40, respirations 12, Oxygen saturation 95% on room air.
Jugular venous pulsations: cannon A waves
Heart sounds are bradycardic with varying intensities of the S1 heart sound, no S3 or S4 heard.

15. What further investigations would you request?

17. What would your management of this patient be?

18. Case 1 - History
A 60 year old man with STEMI 6 weeks ago, suddenly collapsed while working in the backyard
He was brought into ED by ambulance with his wife and remained unconscious
What further questions would you ask about this history

19. Examination
What would you look for on examination?

20. Findings His BP was 60/30 Pulse was not felt
Breathing spontaneously with rapid shallow breaths
Chest clear, HS difficult to auscultate

21. Investigations
A 12 lead ECG was performed

23. Answer VT

24. Investigations
What other investigations would you organise?

25. What would your management of this patient be?

26. History
A 19 year old male was playing football when he felt chest tightness then suddenly collapsed
He has no previous medical history but has some family history ‘heart problems’
What other questions would you ask on history?

27. Family History
His mother mentions that her father had a history of collapsing from his teenage years and died in his mid fifties from sudden cardiac death.
They never investigated it further
Diabetes also runs in the family along with high cholesterol and hypertension

28. A 12 lead ECG was performed

30. Answer
Brugada

31. Examination
Would you expect to find anything significant on physical examination?

32. Management What is the general management of this condition?
Would you order any further investigations on him or his family members?

33. History
A 66 year old lady was brought in with sudden onset of palpitations and chest pain
She reports having a MI 12 years ago
What further questions would you ask on history?

34. Investigations
An ECG was performed…

36. Answer
SVT with RBBB
What other investigations would you order in someone with new onset palpitations?

37. Results TFT – normal ELFT – normal FBC – normal
What else could be triggering these palpitations?
What other tests would you organise to further investiggate this?

38. Management
What is the management of this condition?

39. Example One
Please interpret the following ECG and discuss management

41. Example Two
Please interpret the following ECG and discuss management

43. Example Three
Please interpret the following ECG and discuss management

45. Example Four
Please interpret the following ECG and discuss management