HPI
Case # 6. A 68-year-old woman with a history of CHF presents with lightheadedness and vomiting. The ECG shown below is obtained.
What is the FULL ECG diagnosis? (3 points).
How would you treat this patient? (1 point).
Case # 6 Answer
Atrial fibrillation, complete heart block, junctional escape rhythm, poor R wave progression, classic digoxin toxicity. Treated with pacing as needed (not cardioversion/defibrillation!), digibind for digoxin toxicity
Case # 7. A 45-year-old man presents to the emergency department after a syncopal episode. The ECG shown below is obtained. What is the FULL ECG diagnosis? (3 points).
Case # 7 Answer
Sinus arrhythmia, complete heart block, junctional escape rhythm, right bundle branch block
Case # 8. A 38-year-old woman presents lethargic. She cannot provide any history. The ECG shown below is obtained. What is the likely diagnosis and treatment? (2 points). Name 6 other conditions that produce a rightward axis. (3 points).
Case # 8 Answer
Sodium channel blocker (TCA) toxicity, treated with sodium bicarbonate
DDx of Rightward Axis Deviation
- Ventricular ectopy
- Right ventricular hypertrophy
- Left posterior fascicular block
- Acute pulmonary hypertension (e.g., PE)
- Chronic pulmonary hypertension (g., COPD)
- Old lateral MI (from Q-waves in lead I)
- WPW (Type A)
- Hyperkalemia
- Na+channel blocker toxicity
- Lead misplacement / dextrocardia
- Normal variant in young kids & thin adults with horizontally positioned hearts
Case # 9. A 60-year-old man presents with an altered mental status. He cannot provide any history. His blood pressure is 90/60. The ECG shown below is obtained. What is the diagnosis and immediate treatment of choice? (2 points).
Case # 9 Answer
Hypercalcemia, IV fluids