Wednesday, July 26, 2017

Inferior-Posterior MI

A 70 year old with chest pain.  Past history of hypertension,  prostate hypertrophy, and elevated cholesterol.  BP 188/110.  Received ASA, Hydralazine, Brilinta loading dose, and started on heparin drip.  Transferred for PCI. EKG shows ST elevation in leads II, III, aVF.  Reciprocal depression in I and AVL.  ST depression with tall R waves in V1 and V2.   There is sinus bradycardia with a 1st degree block.  


Tuesday, July 11, 2017

Basic EKG Test 70

01. Identify the following rhythm.

a. Sinus arrhythmia
b. 2nd degree heart block type I
c. Sinus rhythm with an exit block
d. Atrial flutter

02. Identify the following rhythm.

a. Atrial paced
b. Ventricular paced
c. Dual paced
d. Biventricular paced

03. Identify the following rhythm.

a. Sinus rhythm
b. Sinus arrhythmia
c. First degree block
d. Junctional rhythm

04. Identify the following rhythm.

a. Atrial fibrillation
b. Ventricular tachycardia
c. Ventricular fibrillation
d. Torsades de point

05. Identify the following rhythm.

a. Ventricular paced
b. AV paced
c. Biventricular paced
d. Atrial paced

06. Identify the following rhythm.

a. Asystole
b. Ventricular standstill
c. 3rd degree heart block
d. Agonal rhythm

07. Identify the following rhythm.

a. Junctional rhythm
b. Sinus bradycardia
c. Idioventricular rhythm
d. Third degree heart block

08. Identify the following rhythm.

a.  Mobitz II
b. Mobitz I
c. First degree heart block
d. Complete heart block

09. Identify the following rhythm.

a. Junctional rhythm
b. Sinus bradycardia
c. Agonal rhythm
d. Atrial fibrillation

10. Identify the following rhythm.

a. Sinus arrest
b. Agonal rhythm
c. Idioventricular rhythm
d. Wandering atrial pacemaker

11. Identify the following rhythm.

a. Atrial fibrillation
b. Atrial flutter
c. Atrial tachycardia
d. Wandering atrial pacemaker

12. Identify the following rhythm.

a. Ventricular fibrillation
b. Atrial fibrillation
c. Ventricular tachycardia
d. Torsades de pointe

13. Identify the following rhythm.

a. Atrial fibrillation with rapid ventricular response
b. Multifocal atrial tachycardia
c. Supraventricular tachycardia
d. Sinus tachycardia

14. Identify the following rhythm.

a. Ventricular paced with failure to sense
b. Ventricular paced with failure to pace
c. Ventricular paced with failure to capture
d. Demand ventricular pacing

15. Identify the following rhythm.

a. Sinus exit block
b. Sinus arrhythmia
c. Sinus bradycardia
d. Atrial fibrillation

16. Identify the following rhythm.

a. Sinus tachycardia
b. Supraventricular tachycardia
c. Junctional tachycardia
d. Multifocal atrial tachycardia

17. Identify the following rhythm.

a. Ventricular paced
b. AV paced
c. Atrial paced
d. Biventricular paced

18. Identify the following rhythm.

a. Dual paced
b. Biventricular paced
c. Ventricular paced
d. Atrial paced

19. Identify the following rhythm.

a. Ventricular tachycardia
b. 2nd degree AV block type II
c. Accelerated idioventricular rhythm
d. Supraventricular tachycardia

20. Identify the following rhythm.

a. 2nd degree heart block type I
b. First degree heart block
c. 2nd degree heart block type II
d. Complete heart block

21. Identify the following rhythm.

a. Ventricular fibrillation
b. P wave asystole
c. Agonal rhythm
d. Junctional rhythm

22. Identify the following rhythm.

a. Sinus rhythm with couplets
b. Atrial flutter with unifocal PVCs
c. Sinus tachycardia with multifocal PVCs
d. Sinus rhythm with bigeminal PVCs

23. Identify the following rhythm.

a. Sinus rhythm with PJCs
b. Sinus rhythm with PVCs
c. Sinus rhythm with fusion beats
d. Sinus rhythm with PACs

24. Identify the following rhythm.

a. Atrial tachycardia
b. Ventricular tachycardia
c. Sinus tachycardia
d. Supraventricular tachycardia

25. Identify the following rhythm.

a. Sinus rhythm with a couplet
b. Demand ventricular pacing
c. Atrial fibrillation with unifocal PVCs
d. Accelerated junctional rhythm with a couplet

Answers
01. b. 2nd degree heart block type I
02. d. Biventricular paced
03. a. Sinus rhythm
04. c. Ventricular fibrillation
05. d. Atrial paced
06. a. Asystole
07. b. Sinus bradycardia
08. d. Complete heart block
09. a. Junctional rhythm
10. c. Idioventricular rhythm
11. b. Atrial flutter
12. d. Torsades de pointe
13. a. Atrial fibrillation with rapid ventricular response
14. b. Ventricular paced with failure to pace
15. b. Sinus arrhythmia
16. a. Sinus tachycardia
17. a. Ventricular paced
18. a. Dual paced
19. a. Ventricular tachycardia
20. c. 2nd degree heart block type II
21. b. P wave asystole
22. d. Sinus rhythm with bigeminal PVCs
23. d. Sinus rhythm with PACs
24. d. Supraventricular tachycardia
25. b. Demand ventricular pacing


Sunday, July 9, 2017

New Onset of Chest Pain and Dyspnea

A 56 year old with a history of a LBBB block.  The patient had shortness of breath and "fluttering" in the chest for two days.  The patient experienced chest pain with exertion and came to the ER for evaluation.  BP stable.  Labs: K 3.0,  Mg 13. TNI .21, TSH WNL. The 12 lead showed a wide complex tachycardia.  The patient was treated with adenosine 6 mg then 12 mg.  The patient was then treated with IV Diltiazem 25mg x 2 before obtaining rate control. The rate was maintained with Diltiazem 5 mg/hr.


The follow up EKG


Saturday, July 8, 2017

Wolf Parkinson White

A 47 year old patient with new onset of chest pain and shortness of breath. Hx of HTN.  EKG show a rapid atrial fibrillation.  Initial treatment with Diltiazem 10 mg IV x 2, then started on a drip which was titrated up to 10 mg/hr without any change in the rate. The patient was then given Amiodarone 150 mg IV over 10 minutes x 2. The rate and rhythm remained unchanged. The patient was then given Metoprolol 5 mg IV.  This caused a drop in the blood pressure. The patient remained in a rapid atrial fibrillation.  The patient was then cardioverted at 100 J and converted to a junctional rhythm. Follow up EKG show WPW.  TNIs: negative. Electrolytes: WNL,  UDS: + cocaine. (Patient denied any drug hx).


After cardioversion
Follow up EKG



Friday, July 7, 2017

Too Much Beta Blocker

The patient was prescribed metoprolol 12.5mg daily.  His prescription bottle as filled with 50 mg tablets with instruction to take 1/4 tablet daily.  His blood pressure was running high so he decided to take "some extra blood pressure medicine."  He came to the ER with complaints of dizziness and weakness.  In the ER, he was treated with atropine 0.5 mg IV X 2.  BP: 179/88, HR: 35 on admission.


Hospital day 2
2nd degree heart block type II

Second degree heart block type I with trigeminal PVCs



  

Tuesday, July 4, 2017

EKG Quiz- Happy 4th of July America!


01. Identify the following rhythm.

a. Ventricular tachycardia
b. Atrial fibrillation with rapid ventricular response
c. Multifocal atrial tachycardia
d. Supraventricular tachycardia

02. Identify the following rhythm.

a. Sinus tachycardia
b. Torsades de point
c. Supraventricular tachycardia
d. Atrial flutter with rapid ventricular response

03. Identify the following rhythm.

a. Sinus tachycardia
b. Ventricular tachycardia
c. Paroxysmal atrial tachycardia
d. Atrial fibrillation with rapid ventricular response

04. Identify the following rhythm.

a. Atrial fibrillation with rapid ventricular response
b. Ventricular tachycardia
c. Sinus tachycardia
d. Multifocal atrial tachycardia

05. Identify the following rhythm.

a. Ventricular tachycardia
b. Supraventricular tachycardia
c. Torsades de point
d. Atrial flutter with rapid ventricular response

06. Identify the following rhythm.

a. Ventricular tachycardia
b. Ventricular fibrillation
c. Multifocal atrial tachycardia
d. Atrial flutter with rapid ventricular response

07. Identify the following rhythm.
a. Sinus tachycardia
b. Torsades de point
c. Supraventricular tachycardia
d. Atrial flutter with rapid ventricular response

08. Identify the following rhythm.

a. Sinus tachycardia
b. Junctional tachycardia
c. Paroxysmal atrial tachycardia
d. Atrial fibrillation with rapid ventricular response

09. Identify the following rhythm.

a. Sinus tachycardia
b. Ventricular tachycardia
c. Junctional tachycardia
d. Multifocal atrial tachycardia

10. Identify the following rhythm.

a. Ventricular tachycardia
b. Supraventricular tachycardia
c. Torsades de point
d. Atrial flutter with rapid ventricular response


Answers
01. c. Multifocal atrial tachycardia
02. c. Supraventricular tachycardia
03. b. Ventricular tachycardia
04. a. Atrial fibrillation with rapid ventricular response
05. c. Torsades de point
06. b. Ventricular fibrillation
07. d. Atrial flutter with rapid ventricular response
08. b. Junctional tachycardia
09. a. Sinus tachycardia
10. a. Ventricular tachycardia