EKG Workshop - Beyond the Basics · EKG Workshop - Beyond the Basics Dr. Ross MacKenzie FRCPC FACC...
Transcript of EKG Workshop - Beyond the Basics · EKG Workshop - Beyond the Basics Dr. Ross MacKenzie FRCPC FACC...
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
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Asymptomatic 42 year old female
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Baseline ECG Right Arm/Right Leg Exchange
Right Arm/Right Leg Lead Exchange
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Left Arm/Right Leg Lead Reversal
Baseline ECG Left Arm/Right Leg Reversal
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Bilateral Arm-Leg Lead Reversal
Baseline ECG Bilateral Arm-Leg Lead Reversal
48 Year Old Man With a Pacemaker for Congenital Heart Block
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LBBB Pattern Produced by Proper Pacemaker
Catheter Position in RV Apex
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55 Y. O. Male - PH of Possible MI - Pre-ex. Test ECG
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Mason Likar Exercise ECG Electrode Placement Configuration
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Standard ECG Showing Previous Inferior Myocardial Infarction
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47 Year Old Man with History of Previous MI
Asymptomatic 54 Year Old Male Applicant
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56 Year Old Male Entrepreneur Who Had Chest Discomfort One Year Ago While
Travelling in Southeast Asia
41 Y. O. Man - History of Erythema Nodosum Age 14
Fragmented QRS Patterns
38-year old stockbroker – ECG for “age and amount”
Courtesy of Dr. M. Clark
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ECG from 5 years prior to the application
Courtesy of Dr. M. Clark
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Horizontal Vector Loop of Normal R wave Progression
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Anteroseptal Infarction
Horizontal Plane
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Left Ventricular Hypertrophy
Horizontal Plane
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The P Wave in V2 and Technical Errors Recording the Chest
Leads
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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
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Dilated Cardiomyopathy
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40 year old asymptomatic male applicant
36 year old asymptomatic male college basketball coach
36 year old asymptomatic male
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Normal Precordial ST Segment Elevation
24 year old woman with history of palpitations
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Ebstein’s Anomaly
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32 year old male with systolic murmur at the apex
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Primum Atrial Septal Defect Secundum Atrial Septal Defect
Secundum Atrial Septal Defect
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The “Crochetage Sign “ in Atrial Septal Defects
40 Year Old Male – Tetralogy of Fallot Repair Age 5
25 year old asymptomatic male
Brugada ECG Patterns
Brugada Type 1 Pattern
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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
46 year old asymptomatic college professor
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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
21 year old asymptomatic male
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25 year old asymptomatic male
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Epsilon Wave