1. ECG etc… (Miscellaneous ECGs) Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center

2. Objectives Describe the following miscellaneous ECGs: –Lead reversal –Dextrocardia –Hypothermia –Pericarditis –Cardiac Tamponade –Wolff-Parkinson-White –Pulmonary embolism Practice, practice, practice!!!

3. Limb lead reversal Inverted P and QRS in lead I

4. Chest lead reversal Tall precordial R waves

5. Normal ECG

6. Dextrocardia Negative P and QRS in lead I and aVL Reverse R wave progression (differential: lead reversal)

7. Hypothermia Osborn or “J” waves (arrows) Baseline interference from shivering (others: sinus brady, QT prolongation, junctional rhythm, ventricular fibrillation, asystole)

8. Hypothermia

9. Pericarditis Diffuse ST elevations Typically, no reciprocal changes PR displacement

10. Pericarditis

11. Cardiac Tamponade Tamponade Triad (specific, not sensitive): 1.Sinus tachycardia 2.Low voltage QRS 3.Electrical alternans

12. Wolff-Parkinson-White WPW Triad: 1.Short PR interval 2.Wide QRS 3.Delta wave

13. A. Fib with WPW

14. Pulmonary Embolism Clues: Sinus tachycardia S1Q3T3 pattern Incomplete RBBB with R precordial T wave inversions

15. PE

16. Lets’ practice!

17. EKG 1

18. EKG 2

19. EKG 3

20. EKG 4

21. EKG 5

22. EKG 6

23. EKG 7

24. EKG 8

25. Brugada syndrome Defined in 1992 by brothers Pedro and Josep Brugada in J Am Coll Cardiol Rare condition associated with sudden cardiac death (SCD) or ventricular fibrillation/polymorphic VT in structurally normal hearts Mean age of presentation: 35-40 years; male predominance (notably in SE Asia where it is endemic) Familial with autosomal dominant inheritance Clinical presentation: syncope or SCD is most common initial event; typically occurs in sleep or in early morning ECG criteria: ST segment elevation in V1-V3 with characteristic RBBB pattern Defect in sodium channel gene (SCN5A) on chromosome 3 Lifetime risk of SCD Consider ICDs; refer for genetic counseling

26. The End