2025 ECG Competition Answers (Part 1/3)

This week we review the answers to questions 1-5 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.

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1. A 36 yo W presents after an episode of palpitations and near-syncope. Her BP is 115/60. She is awake and alert. What is the FULL ECG diagnosis? (3 points)

Question # 1 Answer

• Sinus rhythm, nonspecific T wave abnormality (flattening), arrhythmogenic cardiomyopathy.

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2. A 75 yo M presents complaining of palpitations. BP is 125/75. What is the FULL ECG diagnosis? (3 points)

Question # 2 Answer

• Atrial fibrillation w/RVR, RBBB, inferior MI of undetermined age.

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3. A 74 yo M presents with weakness. His BP is 82/50. What is the FULL ECG diagnosis? (2 points) What is the best initial treatment? (2 points)

Question # 3 Answer

• Dx: Sinus rhythm with Mobitz I AV conduction; Tx: IV fluids.

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4. A 67 yo W presents with severe malaise and confusion. BP is 115/50. What is the FULL ECG diagnosis? (2 points)

Question # 4 Answer

• Sinus rhythm, short QT → hypercalcemia.

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5. A 54 yo M presents with episodes of palpitations and near-syncope. What is the FULL ECG diagnosis? (5 points)

Question # 5 Answer

• Sinus rhythm with AV dissociation, ventricular escape rhythm, occasional captured beats with RBBB conduction.