EKG Workshop - Beyond the Basics -...
-
Upload
nguyendang -
Category
Documents
-
view
215 -
download
0
Transcript of EKG Workshop - Beyond the Basics -...
![Page 1: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/1.jpg)
EKG Workshop -
Beyond the Basics
Dr. Ross MacKenzie FRCPC FACC
2012 AAIM Annual Meeting – San Diego 1
ECG Workshop
Objectives:
•Beyond the basics
•Common ECG underwriting challenges
•Newer ECG patterns with mortality implications
•Focus on ECG morphology
2
![Page 2: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/2.jpg)
Asymptomatic 42 year old female
4
Baseline ECG Right Arm/Right Leg Exchange
Right Arm/Right Leg Lead Exchange
![Page 3: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/3.jpg)
5
Left Arm/Right Leg Lead Reversal
Baseline ECG Left Arm/Right Leg Reversal
6
Bilateral Arm-Leg Lead Reversal
Baseline ECG Bilateral Arm-Leg Lead Reversal
![Page 4: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/4.jpg)
48 Year Old Man With a Pacemaker for Congenital Heart Block
8
LBBB Pattern Produced by Proper Pacemaker
Catheter Position in RV Apex
![Page 5: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/5.jpg)
9
55 Y. O. Male - PH of Possible MI - Pre-ex. Test ECG
10
Mason Likar Exercise ECG Electrode Placement Configuration
![Page 6: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/6.jpg)
11
Standard ECG Showing Previous Inferior Myocardial Infarction
12
47 Year Old Man with History of Previous MI
![Page 7: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/7.jpg)
Asymptomatic 54 Year Old Male Applicant
13
56 Year Old Male Entrepreneur Who Had Chest Discomfort One Year Ago While
Travelling in Southeast Asia
![Page 8: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/8.jpg)
41 Y. O. Man - History of Erythema Nodosum Age 14
Fragmented QRS Patterns
![Page 9: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/9.jpg)
38-year old stockbroker – ECG for “age and amount”
Courtesy of Dr. M. Clark
18
ECG from 5 years prior to the application
Courtesy of Dr. M. Clark
![Page 10: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/10.jpg)
19
Horizontal Vector Loop of Normal R wave Progression
20
Anteroseptal Infarction
Horizontal Plane
![Page 11: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/11.jpg)
21
Left Ventricular Hypertrophy
Horizontal Plane
22
The P Wave in V2 and Technical Errors Recording the Chest
Leads
![Page 12: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/12.jpg)
23
Changing P-Wave Morphology in Lead V2
Ilg KJ, et al, Am J Med 2012; 125:23.
49 year old woman who had a severe episode of gastroenteritis after climbing Mount
Kilimanjaro in Tanzania
![Page 13: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/13.jpg)
25
Dilated Cardiomyopathy
26
40 year old asymptomatic male applicant
![Page 14: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/14.jpg)
36 year old asymptomatic male college basketball coach
![Page 15: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/15.jpg)
36 year old asymptomatic male
29
Normal Precordial ST Segment Elevation
![Page 16: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/16.jpg)
24 year old woman with history of palpitations
32
Ebstein’s Anomaly
![Page 17: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/17.jpg)
33
32 year old male with systolic murmur at the apex
34
Primum Atrial Septal Defect Secundum Atrial Septal Defect
![Page 18: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/18.jpg)
Secundum Atrial Septal Defect
35
36
The “Crochetage Sign “ in Atrial Septal Defects
![Page 19: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/19.jpg)
40 Year Old Male – Tetralogy of Fallot Repair Age 5
25 year old asymptomatic male
![Page 20: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/20.jpg)
Brugada ECG Patterns
Brugada Type 1 Pattern
40
![Page 21: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/21.jpg)
Borderline Brugada PatternDrug Challenge
Saddleback Pattern Changes When V1 and V2 Are Moved To The Second and Third
Intercostal space (V2IC2 and V2IC3) Overlying the Right Ventricular Outflow Tract
Meregalli P G et al. Cardiovasc Res 2005;67:367-378
![Page 22: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/22.jpg)
46 year old asymptomatic college professor
43
44
Incidence of T wave Inversion Beyond V1 and V2
In ages 19-45
< 4% in women
< 1% in men
In middle-aged subjects 36-50
< 0.7%
Marcus F. Am J Cardiol 2005; 95:1070
Aro AL. Circulation 2012; 125:1272
![Page 23: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/23.jpg)
21 year old asymptomatic male
45
25 year old asymptomatic male
46
![Page 24: EKG Workshop - Beyond the Basics - AAIMaaimedicine.org/.../EKGs-BeyondtheBasics-Huguenard_MacKenzie-Oct22.pdf•Beyond the basics ... The “Crochetage Sign “ in Atrial Septal Defects](https://reader031.fdocuments.in/reader031/viewer/2022030507/5ab56c5c7f8b9a6e1c8cd1fd/html5/thumbnails/24.jpg)
47
Epsilon Wave