ECG: The Acute SettingECG: The Acute Setting

Ahmed El-Damaty, MDLecturer oF CardiologyElectrophysiology and Pacing ServiceCairo University

Theme I:Theme I:

Bradyarrhythmias Bradyarrhythmias

74 yr-old lady with frequent 74 yr-old lady with frequent syncope. What is the most syncope. What is the most accurate diagnosis?accurate diagnosis?

52 year old female, asymptomatic

54 year old male during acute chest 54 year old male during acute chest painpain

60 year old male, H/O remote MI, 60 year old male, H/O remote MI, asymptomatic asymptomatic

44 years old male with acute chest pain44 years old male with acute chest pain

61 year old male presenting with inferior MI61 year old male presenting with inferior MI

Theme II:Theme II:

Narrow complex tachycardiaNarrow complex tachycardia

Differential Diagnosis of Differential Diagnosis of SVTSVT

• AVNRT (60%)• AVRT (30%)• AT (10%)• JT (1%)

AVNRTAVNRT

AVRTAVRT

ATAT

47 year old female presenting with tachycardia

18 year old male presenting with tachycardia

64 year old male presenting with progressive shortness of breath over the last 2 months

Telemetry recording for a 57 year old ischemic patient

Theme III: Theme III:

WidE complex tachycardiaWidE complex tachycardia

Wide Wide ComplexTachycardiasComplexTachycardias

Ventricular TachycardiaSVT with aberrancy SVT with pre-excitationPMTArtifacts

ECG DiagnosisECG Diagnosis

♥ Exclude artifacts and paced rhythm

♥ AV relationship♥ Morphology

60 year old male with ICM presenting with lightheadedness

55 year old male with history of IHD presenting with palpitations

76 year old male with ICM presenting with syncope

13-year old male with history of heart racingWhat is the most likely diagnosis?

13-year old male with history of heart racingWhat is the diagnosis?

19-year old male presenting with this tachycardia

38 year old male presenting with 38 year old male presenting with palpitationspalpitations

60 year old gentleman presenting with presyncope with this tracing recorded during monitoring in the ER

ECG recorded directly after exercise in a 16 yrs old patient with strong FH of SCD

Theme IV:Theme IV:

Miscellaneous ECG PatternsMiscellaneous ECG Patterns

60 year old male with ICD and CRF60 year old male with ICD and CRF

46-year old male with palpitations

56 year old female with H/O renal failure on 56 year old female with H/O renal failure on regular hemodialysisregular hemodialysis

28 yr-old male with repeated syncope, 28 yr-old male with repeated syncope, heart racing and a sister who died heart racing and a sister who died suddenly at age 30ysuddenly at age 30y

40 yr-old completely healthy 40 yr-old completely healthy male with atypical chest painmale with atypical chest pain

20 year old male presenting with 20 year old male presenting with syncopesyncope

23 year old female presenting with 23 year old female presenting with recurrent syncope on beta blocker recurrent syncope on beta blocker

34 year old male resuscitated from a drowning 34 year old male resuscitated from a drowning accident accident

69 year old male presenting with acute chest 69 year old male presenting with acute chest painpain

23 year old male presenting with acute chest 23 year old male presenting with acute chest painpain

Thank youThank you