2024 ECG Competition Answers (Part 1/2)

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."

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.

1. Please list the indications for emergent cath lab activation for presumed acute coronary occlusion/occlusion MI. (6 points)

Question # 1 Answer

• ST segment elevation in contiguous leads (including post-arrest STEMI)
• Posterior STEMI
• LBBB of RV paced rhythms with revised Sgarbossa criteria
• de Winter T wave pattern
• Non ST-segment elevation ACS with intractable ischemia, hemodynamic or electrical instability, or evolving acute heart failure

2. A 45 yo M presents with CP. His BP is 115/60. He is awake and alert. What is the FULL ECG diagnosis? (3 points)

Question # 2 Answer

• Normal sinus rhythm, acute inferior and right ventricular MI
• RV MI is suggested by the ST elevation seen in V1 in association with the ST depression in V2

3. A 45 yo W presents complaining of palpitations. BP is 125/75. What is the diagnosis? Name 2 options for immediate management.
(4 points)

Question # 3 Answer

• Atrial fibrillation with WPW
• Treatment with procainamide or synchronized cardioversion

4. A 60 yo W presents with palpitations and dyspnea. The ECG is below. What is the FULL ECG diagnosis? (4 points)

Question # 4 Answer

• Atrial flutter with variable conduction, LVH, RBBB

5. A 68 yo M with a history of CHF presents with CP and vomiting. What is the FULL ECG diagnosis? (4 points)

Question # 5 Answer

• Normal sinus rhythm or sinus tachycardia, high grade AV block (not a complete heart block), inferior and posterior STEMI