STAT ECG Diagnoses: a holosystolic murmur and a crochetage ECG pattern in a patient with palpitations

ECG Weekly Workout with Dr. Amal Mattu


 A 25-year-old male presents for evaluation of gradually worsening shortness of breath over the past year. He reports the symptoms as mild and associated with occasional palpitations but is otherwise well. Exam reveals a 2/6 holosystolic murmur in the left upper sternal border with a fixed split S2. The following ECG is obtained:

Before watching the video, look closely at this ECG and ask yourself these questions:

  1. What ECG abnormalities do you notice?
  2. What is the most likely cause of the notching seen in the inferior leads?
  3. What is the next best diagnostic test?