2024 ECG Competition Answers (Part 2/2)

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.

6. A 35 yo W presents with numerous episodes of palpitations and near-syncope. What is the likely cause of the palpitations/near-syncope, and give the FULL ECG diagnosis and treatment? (4 points)

Question # 6 Answer

• Normal sinus rhythm, prolonged QT interval, septal MI (uncertain age), T wave abnormality consistent with diffuse ischemia; Tx - Calcium

7. A 60 yo M presents with chest pain and dyspnea. His BP is 118/67. What is the ECG interpretation, the underlying cause of this, and the immediate treatment of choice? (4 points)

Question # 7 Answer

• Normal sinus rhythm with de Winter T waves, acutely unstable proximal LAD occlusion; Tx - emergent cath

8. A 30 yo M presents with progressive fatigue, dyspnea on exertion, palpitations and recent syncope. What is the expected cardiopulmonary exam finding and the FULL ECG diagnosis? (4 points)

Question # 8 Answer

• Usually produces a systolic murmur (or diastolic rumble over tricuspid valve); atrial fibrillation, incomplete right bundle branch block (tall R wave in V1 - signs of right heart strain), crochetage pattern consistent with atrial septal defect (ASD)

9. A 68 yo W presents with lightheadedness, nausea, and vomiting. The following ECG is obtained. What is the FULL ECG diagnosis and treatment? (4 points)

Question # 9 Answer

• Sinus tachycardia with PVCs, ST segment depression consistent with diffuse ischemia, long QT interval, all suggestive of severe  hypokalemia; treat with potassium

10. A 43 yo M presents with a palpitations. His ECG is below. What is the FULL ECG diagnosis? (4 points)

Question # 10 Answer

• Normal sinus rhythm with PVCs, competing accelerated junctional pacemaker (sinus rhythm, then AV dissociation with accelerated junctional rhythm), poor R wave progression, inferior ischemia

11. 35 yo W presents with palpitations after a syncopal episode earlier in the day. What is the FULL ECG diagnosis? (4 points)

Question # 11 Answer

• Sinus rhythm with WPW, junctional trigeminy