TWO INTERESTING TWO INTERESTING ECGsECGs

Dr Jishanth MDr Jishanth M

Prof. Dr E Dhandapani’s unitProf. Dr E Dhandapani’s unit

► Selvam 35 yr old male Selvam 35 yr old male ► ECG findings:ECG findings:► Sinus rhythmSinus rhythm► Rate- 100/min, regularRate- 100/min, regular► Axis +30 degree,Axis +30 degree,► Normal P wave, PR interval 0.14 sec,Normal P wave, PR interval 0.14 sec,

► QRS duration 0.1 sec,QRS duration 0.1 sec,► ST elevation in L1, L2, aVF, V4-V6ST elevation in L1, L2, aVF, V4-V6► T wave inversion in L3, aVFT wave inversion in L3, aVF

► Raja 23 yr old maleRaja 23 yr old male► ECG findings:ECG findings:► Sinus rhythmSinus rhythm► Rate 80/min, regularRate 80/min, regular► Axis 60 degreeAxis 60 degree► Normal P wave, PR interval 0.16 secNormal P wave, PR interval 0.16 sec► QRS duration 0.08 sec,QRS duration 0.08 sec,► QTc- 0.48 sec (prolonged)QTc- 0.48 sec (prolonged)► ST elevation in V1-V3ST elevation in V1-V3► ST depression in L1, L2, aVL, V5, V6ST depression in L1, L2, aVL, V5, V6► T wave inversion in L1, L2, aVL, V2-V6T wave inversion in L1, L2, aVL, V2-V6

BIOCHEMICAL MARKERSBIOCHEMICAL MARKERS

► CASE 1CASE 1► Trop T +veTrop T +ve

► Case 2Case 2► CK MB NormalCK MB Normal► Trop T NormalTrop T Normal

CASE 1CASE 1 CASE 2CASE 2

► Selvam35 yr old male Selvam35 yr old male ► Admitted with RTA in Admitted with RTA in

surgical ward with chest surgical ward with chest injury, developed left injury, developed left sided hemothorax , ICD sided hemothorax , ICD insertedinserted

► Paradoxical respiratory Paradoxical respiratory movement, sternal movement, sternal fracture confirmed by fracture confirmed by lateral view chest x-raylateral view chest x-ray

► ECHO- no evidence of ECHO- no evidence of tamponade or effusiontamponade or effusion

► ECG- ECG- ► Trop T +veTrop T +ve

► Raja 23 yr old maleRaja 23 yr old male► Admitted with left sided Admitted with left sided

weakness and slurring weakness and slurring of speech, sudden onsetof speech, sudden onset

► CT BRAIN- Pontine CT BRAIN- Pontine hemorrhagehemorrhage

► ECG- ECG-

► CK- MB level was CK- MB level was normalnormal

► Trop T was normalTrop T was normal

CASE 1CASE 1 CASE 2CASE 2

► POST-TRAUMATIC POST-TRAUMATIC MYOPERICARDITISMYOPERICARDITIS

► PONTINE HEMORRHAGEPONTINE HEMORRHAGE

ACUTE MYOPERICARDITISACUTE MYOPERICARDITIS PONTINE HEMORRHAGE/CVAPONTINE HEMORRHAGE/CVA

► Diffuse ST elevationDiffuse ST elevation► PR segment elevation in PR segment elevation in

aVRaVR► With reciprocal PR With reciprocal PR

depression in other depression in other leadsleads

► ST elevation may be ST elevation may be followed by T wave followed by T wave inversion after a inversion after a variable period variable period

► Myocarditis can produce Myocarditis can produce Q waves- so called Q waves- so called PSEUDO-INFARCTPSEUDO-INFARCT

► Prominent primary T Prominent primary T wave inversion- wave inversion- diffuse diffuse

► Associated with QT Associated with QT prolongationprolongation

► Widely splayed Widely splayed appearance of T wavesappearance of T waves

► SAH- transient ST SAH- transient ST elevation and elevation and arrhythmias including arrhythmias including Torsades de pointesTorsades de pointes

ACUTE PERICARDITISACUTE PERICARDITIS

► NON-INFARCTION TRANSMURAL ISCHEMIANON-INFARCTION TRANSMURAL ISCHEMIAPrinzmetal angina patternPrinzmetal angina pattern

Takotsubo syndromeTakotsubo syndrome

► POST MI (ventricular aneurysm pattern)POST MI (ventricular aneurysm pattern)► Acute PericarditisAcute Pericarditis► Normal variant (early repolarization pattern)Normal variant (early repolarization pattern)► LVH, LBBB (V1-V2 or V3 only)LVH, LBBB (V1-V2 or V3 only)► Others- myocardial injury, myocarditis, tumor invading Others- myocardial injury, myocarditis, tumor invading

left ventricle, left ventricle, trauma to the ventriclestrauma to the ventricles► After D.C. cardioversionAfter D.C. cardioversion► Brugada pattern( RBBB pattern with ST elevation in right Brugada pattern( RBBB pattern with ST elevation in right

pericardial leads)pericardial leads)► Type 1C anti-arrhythmic drugs (V1-V2)Type 1C anti-arrhythmic drugs (V1-V2)► Hypothermia (J wave, Osborn wave)Hypothermia (J wave, Osborn wave)► Intra cranial hemorrhageIntra cranial hemorrhage► Hyperkalemia (most apparent in V1-V2)Hyperkalemia (most apparent in V1-V2)► Hypercalcemia (V1-V2) Hypercalcemia (V1-V2)

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