2025 ECG Competition Answers (Part 2/3)

This week we review the answers to questions 6-9 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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6. A 42 yo W presents with dyspnea. Her BP is 118/67. What is the FULL ECG diagnosis? (2 points) List 6 other causes of right axis deviation. (3 points)

Question # 6 Answer

• Dx: sinus rhythm, dextrocardia (& low voltage).

• DDx/o RAD: ventricular ectopy, right ventricular hypertrophy, left posterior fascicular block, pulmonary hypertension (acute or chronic), old lateral MI, WPW, sodium channel blocking drugs, hyperkalemia, misplaced leads, dextrocardia, normal variant in newborns/infants.

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7. A 92 yo M presents with lightheadedness and dyspnea. BP is 85/55. What is the FULL ECG diagnosis? (3 points) What is the best immediate treatment? (2 points)

Question # 7 Answer

• Atrial flutter, complete heart block, junctional escape rhythm w/RBBB (or would accept ventricular escape rhythm).

• Tx: pace (not shock!)

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8. A 87 yo M presents with chest pain, nausea, and vomiting. BP is 110/65. What is the FULL ECG diagnosis? (6 points)

Question # 8 Answer

• Sinus tachycardia, complete heart block, junctional escape rhythm, RBBB & LPFB (or would accept old lateral MI), anterior STEMI.

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9. 26 yo W presents unresponsive. BP 85/45.
What is the FULL ECG diagnosis? (2 points)
List 4 ECG findings often associated with this condition. (2 points)

Question # 9 Answer

• Rhythm is a bit uncertain, but the main thing I'm looking for here is dx-hypothermia; hypothermia ECG findings: J waves, tremor artifact, sinus tachy (early), bradycardia (sinus, junctional, or slow afib), prolongation of all intervals, VFib, eventually asystole.

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10. A 69 yo M presents with lightheadedness.
What is the FULL ECG diagnosis? (3 points)

Question # 10 Answer

• Description of the rhythm is accepted: atrial bradycardia with junctional escape beats that are followed by atrial captured beats…formal term is "(junctional) escape-capture bigeminy".