2025 ECG Competition Answers (Part 3/3)

Annual UMEM Residency ECG Competition by Dr. Amal Mattu

This week we review the answers to questions 10-14 from the 13th Annual UMEM Residency ECG Competition. Make sure to attempt to answer the questions yourself before watching the video or clicking the answer boxes in the summary section to reveal the answers and take home points!

Instructions from Dr. Mattu: In some of the following questions, I’ll ask you for a FULL ECG interpretation/diagnosis. Here’s what I am asking for:

SAMPLE QUESTION: A 58 yo M presents with chest pain and the ECG noted below. What is the FULL ECG diagnosis? (5 points)

Sample Answer

Answer:
Sinus tachycardia, complete heart block, junctional escape rhythm, RBBB, diffuse ischemia

In this example, I would give you 1 point for identifying the atrial rhythm (ST), one point for identifying CHB, 1 point for identifying that there is a junctional escape, 1 point for identifying the RBBB, and one point for noting the ischemia (ST depression in multiple leads). In other words...be complete in your interpretation!

Be sure that you don’t just describe what you see....interpret the ECG! For example, I don’t want you to say “ST depression in __ leads.” I want you to say “diffuse ischemia.”

Also, in your interpretation, if you think there’s an underlying issue, say it. For example, if you think the underlying dx is hyperK, or TCA OD, or Brugada, etc., say it.

Don’t assume that points correlate with the number of things I am looking for. For example, if something is worth 3 points, that does NOT mean there are 3 things you need to list! Points are allotted based on how important I think something is.

Sample Answer

 

10. A 69 yo M presents with lightheadedness.
What is the FULL ECG diagnosis? (3 points)

ECG10

Question # 10 Answer

  • A simple description of the rhythm was accepted as a correct answer for this bonus question: atrial bradycardia with junctional escape beats that are followed by atrial captured beats…formal term is “(junctional) escape-capture bigeminy”. See related ECG STAT post to learn more about this. 
Question # 10 Answer

11. What is the Bix rule? (2 points)

Question # 11 Answer

  • Bix rule: when you see an atrial beat ½ way between two QRS complexes, suspect atrial flutter!

Question # 11 Answer

12. What is Ashman phenomenon? (2 points)

Question # 12 Answer

  • Ashman phenomenon: aberrant conduction usually associated with rapid atrial fibrillation, typically causes a RBBB morphology.
Question # 12 Answer

13. Describe (or draw) what de Winter T waves are, in which leads you find them, and what they predict in the cath lab. (3 points)

Question # 13 Answer

  • de Winter T waves: ST depression with hyperacute/tall symmetric T waves in the mid-precordial leads (V2, V3, V4) that occur during ACS Sx’s, typically indicate an acute proximal LAD blockage; this is now an indication for immediate cath.
Question # 13 Answer

14. Describe the Aslanger pattern and what it predicts in the cath lab. (3 points)

Question # 14 Answer

  • Aslanger pattern: STE in III but not the other inferior leads; ST is higher in V1 than V2; lateral STD with terminally-upright Ts; predicts acute left Cx or RCA blockage This is not yet an indication for immediate cath, but there is increasing literature suggesting that it probably should be.
Question # 14 Answer