2021 ECG Competition Answers (Part 2/2)

 

Question #8:  This 85-year old man presented with palpitations.

What is the FULL ECG diagnosis? (2 pts)

Case # 8 Answer

8. Atrial tachycardia with Mobitz I AV block (2 points)

Question #9:  An 85-year-old man awaiting admission for GI problems had a telemetry alarm go off transiently, and the nurse printed this 12-lead from the event. He is currently back in sinus rhythm and doing fine.

What is your management after reviewing this ECG? (2 pts)

Case # 9 Answer

9. This is artifact…check the leads (2 points)

Question #10:  A 71-year-old man presents after a syncopal episode. This is his ECG.

What is the FULL ECG diagnosis? (3 pts)

Case # 10 Answer

10. Sinus rhythm or sinus tachycardia, right bundle branch block/left anterior fascicular block, Mobitz II/Advanced AV block, one aberrantly conducted beat (3 points)

Question #11: A 49-year-old man presents with malaise, chest pressure, dyspnea, and nausea. BP 85/40.

11a. What is the diagnosis? (1 pt)
11b. Name two other conditions that, when severe, can produce STE in V1 + V2 + aVR, with RAD (2 pts)
11c. Explain why this condition can produce a Brugada pattern in V1-V2 (1 pt)

Case # 11 Answer

11 a. Severe hyperkalemia (1 point)

11 b. Pulmonary embolism, sodium channel blocker toxicity (2 points)

11 c. Both are sodium channelopathies (1 point)

Question#12: You just got sign-out on a 40 yo W with intractable nausea/vomiting and chest pain presumably due to cannabis-related hyperemesis + gastritis. Labs ok, but no EKG was done. The nurse brings you this rhythm strip which was just pulled up from the monitor.

12a. What's the diagnosis? (2 pts)

12b. What medication is best, specifically for this rhythm? (1 pt)

12c. Explain your answer to 12b. (1 pt)

Case # 12 Answer

12 a. Inferior STEMI + NSVT (monomorphic) (2 points)

12 b. Beta blockers (1 point)

12 c. Reduction of sympathetic tone (1 point)

Question # 13 -  BONUS: This is a 61-year-old man with nausea, malaise, lightheadedness, and palpitations all day. He presents with this ECG. His first TN-I is negative.

13a. What is the likely dx?
13b. List as many causes of STE as you can think of

Case # 13 Answer

13 a. Hypercalcemia

13 b. The many causes of ST-segment elevation

• Acute myocardial injury (acute coronary occlusion or trauma)
• Global ischemia (e.g., Epinephrine administration, dissection, massive GI bleeding, etc.)
• Early Repolarization
• Myo/pericarditis
• Vasospasm
• Ventricular aneurysm
• LBBB/pacemaker
• Pulmonary embolism
• LVH/high left ventricular voltage (WPW, athlete's heart, etc.)
• Na⁺channelopathy (e.g., Brugada syndrome & mimics, TCA's, etc.)
• Post-cardioversion (stunning)
• Hyperkalemia
• Hypothermia
• Takotsubo cardiomyopathy
• Intracranial abnormalities
• "Spiked Helmet" sign
• Hypercalcemia