Slide 1

70 yr old with lethargy and presyncope Type II AV block Mobitz II

Slide 2

Same patient few minutes later Type II block Wenkebach/Mobitz I

Slide 3

Same patient yet again Complete heart block Third degree block

Slide 4

70 yr old with lethargy and syncope Trifascicular block 1 st degree HB, RBBB and LAD (L anterior hemiblock)

Slide 5

Fusion beat Capture beats Monomorphic VT 50 yr old with palpitations

Slide 6

R on T causing polymorphic VT = Torsade's du pointe

Slide 7

Ventricular Fibrillation You dont want this for your patient

Slide 8

30 yr old male with syncope Brugada Syndrome

Slide 9

ECG Findings Three types ST elevation v1 v3 > 2mm Complete or incomplete RBBB T-wave types 1. Inverted 2. Biphasic 3. Upright

Slide 10

Brugada Why do we care? Predisposition to polymorphic ventricular tachycardia Identification and treatment with AICD may prevent a young sudden cardiac death

Slide 11

Arrthymogenic RV cardiomyopathy/dysplasia - inverted T waves in leads V 1 through V 5. Arrowheads point to late RV activation, called an epsilon wave 25 year old with syncope on exercising

Slide 12

When to refer cardiac syncope to ED All 2 nd degree and 3 rd degree heart blocks All trifascicular blocks All rapid AF >120 All SVTs in not terminated by Valsalva manouvre funny looking ST/T segments discuss/fax Asymptomatic patients with WPW, ST changes can be referred to cardiology OPA

Slide 13

Important contact details for Northern Hospital Nov 2013 Clinical ED Consultant 8405 2610/8405 8610 ED Fax 8405 8633 EMET/General enquiries 8405 8013 (Kim Tarzia ED secretary) EMET queries to Dr Cynthia Lim, Dr Peter Jordan, Dr Megan Robb ED Director Dr Shyaman Menon EMET presentations : www.nhedventures.comwww.nhedventures.com Adult Outpatients 8405 8850/8405 8335 Fax 8405 8761 Cardiology 8405 8859 Fax 8405 8405 (currently 3 month wait for Chest pain clinic) Paediatric/Paed Surgery OPA 8405 8417 Fax 8405 8449 (current 4-6 week)(apmt sent 1 week) Paediatric Surg Fax 8405 8449 (within a week)

Slide 14

www.nhedventures.com Click on EMET on left to access presentations provided. Registrar education sessions and interesting education links

Slide 15

70 yr old with lethargy and presyncope Type II AV block Mobitz II

Slide 16

Same patient few minutes later Type II block Wenkebach/Mobitz I

Slide 17

Same patient yet again Complete heart block Third degree block

Slide 18

70 yr old with lethargy and syncope Trifascicular block 1 st degree HB, RBBB and LAD (L anterior hemiblock)

Slide 19

Fusion beat Capture beats Monomorphic VT 50 yr old with palpitations

Slide 20

R on T causing polymorphic VT = Torsade's du pointe

Slide 21

Ventricular Fibrillation You dont want this for your patient

Slide 22

30 yr old male with syncope Brugada Syndrome

Slide 23

ECG Findings Three types ST elevation v1 v3 > 2mm Complete or incomplete RBBB T-wave types 1. Inverted 2. Biphasic 3. Upright

Slide 24

Brugada Why do we care? Predisposition to polymorphic ventricular tachycardia Identification and treatment with AICD may prevent a young sudden cardiac death

Slide 25

Arrthymogenic RV cardiomyopathy/dysplasia - inverted T waves in leads V 1 through V 5. Arrowheads point to late RV activation, called an epsilon wave 25 year old with syncope on exercising

Slide 26

When to refer cardiac syncope to ED All 2 nd degree and 3 rd degree heart blocks All trifascicular blocks All rapid AF >120 All SVTs in not terminated by Valsalva manouvre funny looking ST/T segments discuss/fax Asymptomatic patients with WPW, ST changes can be referred to cardiology OPA

Slide 27

Important contact details for Northern Hospital Nov 2013 Clinical ED Consultant 8405 2610/8405 8610 ED Fax 8405 8633 EMET/General enquiries 8405 8013 (Kim Tarzia ED secretary) EMET queries to Dr Cynthia Lim, Dr Peter Jordan, Dr Megan Robb ED Director Dr Shyaman Menon EMET presentations : www.nhedventures.comwww.nhedventures.com Adult Outpatients 8405 8850/8405 8335 Fax 8405 8761 Cardiology 8405 8859 Fax 8405 8405 (currently 3 month wait for Chest pain clinic) Paediatric/Paed Surgery OPA 8405 8417 Fax 8405 8449 (current 4-6 week)(apmt sent 1 week) Paediatric Surg Fax 8405 8449 (within a week)

Slide 28

www.nhedventures.com Click on EMET on left to access presentations provided. Registrar education sessions and interesting education links