70 yr old with lethargy and presyncope
DESCRIPTION
70 yr old with lethargy and presyncope. Type II AV block – Mobitz II. Same patient few minutes later. Type II block – Wenkebach/Mobitz I . Same patient yet again…. Complete heart block – Third degree block. 70 yr old with lethargy and syncope. - PowerPoint PPT PresentationTRANSCRIPT
70 yr old with lethargy and presyncope
Type II AV block – Mobitz II
Same patient few minutes later
Type II block – Wenkebach/Mobitz I
Same patient yet again…
Complete heart block – Third degree block
70 yr old with lethargy and syncope
Trifascicular block – 1st degree HB, RBBB and LAD (L anterior hemiblock)
Fusion beat
Capture beats
Monomorphic VT
50 yr old with palpitations
R on T causing polymorphic VT = Torsade's du pointe
Ventricular Fibrillation
You don’t want this for your patient
30 yr old male with syncope
Brugada Syndrome
Brugada Syndrome
• ECG Findings– Three types – ST elevation v1 – v3 >
2mm– Complete or incomplete
RBBB• T-wave α types
– 1. Inverted– 2. Biphasic– 3. Upright
Brugada – Why do we care?
• Predisposition to polymorphic ventricular tachycardia• Identification and treatment with AICD may prevent a young sudden cardiac death
Arrthymogenic RV cardiomyopathy/dysplasia - inverted T waves in leads V1 through V5. Arrowheads point to late RV activation, called an epsilon wave
25 year old with syncope on exercising
When to refer cardiac syncope to ED
• All 2nd degree and 3rd degree heart blocks
• All trifascicular blocks
• All rapid AF >120
• All SVTs in not terminated by Valsalva manouvre
• “funny looking” ST/T segments – discuss/fax
• Asymptomatic patients with WPW, ST changes can be referred to cardiology OPA
Important contact details for Northern Hospital Nov 2013
Clinical ED Consultant – 8405 2610/8405 8610ED Fax – 8405 8633
EMET/General enquiries – 8405 8013(Kim Tarzia ED secretary)EMET queries to Dr Cynthia Lim, Dr Peter Jordan, Dr Megan RobbED Director – Dr Shyaman MenonEMET presentations : www.nhedventures.com
Adult Outpatients – 8405 8850/8405 8335Fax – 8405 8761Cardiology – 8405 8859Fax – 8405 8405(currently 3 month wait for Chest pain clinic)
Paediatric/Paed Surgery OPA – 8405 8417 Fax – 8405 8449 (current 4-6 week)(apmt sent 1 week)Paediatric Surg Fax – 8405 8449 (within a week)
www.nhedventures.com
Click on EMET on left to access presentations provided.
Registrar education sessions and interesting education links
70 yr old with lethargy and presyncope
Type II AV block – Mobitz II
Same patient few minutes later
Type II block – Wenkebach/Mobitz I
Same patient yet again…
Complete heart block – Third degree block
70 yr old with lethargy and syncope
Trifascicular block – 1st degree HB, RBBB and LAD (L anterior hemiblock)
Fusion beat
Capture beats
Monomorphic VT
50 yr old with palpitations
R on T causing polymorphic VT = Torsade's du pointe
Ventricular Fibrillation
You don’t want this for your patient
30 yr old male with syncope
Brugada Syndrome
Brugada Syndrome
• ECG Findings– Three types – ST elevation v1 – v3 >
2mm– Complete or incomplete
RBBB• T-wave α types
– 1. Inverted– 2. Biphasic– 3. Upright
Brugada – Why do we care?
• Predisposition to polymorphic ventricular tachycardia• Identification and treatment with AICD may prevent a young sudden cardiac death
Arrthymogenic RV cardiomyopathy/dysplasia - inverted T waves in leads V1 through V5. Arrowheads point to late RV activation, called an epsilon wave
25 year old with syncope on exercising
When to refer cardiac syncope to ED
• All 2nd degree and 3rd degree heart blocks
• All trifascicular blocks
• All rapid AF >120
• All SVTs in not terminated by Valsalva manouvre
• “funny looking” ST/T segments – discuss/fax
• Asymptomatic patients with WPW, ST changes can be referred to cardiology OPA
Important contact details for Northern Hospital Nov 2013
Clinical ED Consultant – 8405 2610/8405 8610ED Fax – 8405 8633
EMET/General enquiries – 8405 8013(Kim Tarzia ED secretary)EMET queries to Dr Cynthia Lim, Dr Peter Jordan, Dr Megan RobbED Director – Dr Shyaman MenonEMET presentations : www.nhedventures.com
Adult Outpatients – 8405 8850/8405 8335Fax – 8405 8761Cardiology – 8405 8859Fax – 8405 8405(currently 3 month wait for Chest pain clinic)
Paediatric/Paed Surgery OPA – 8405 8417 Fax – 8405 8449 (current 4-6 week)(apmt sent 1 week)Paediatric Surg Fax – 8405 8449 (within a week)
www.nhedventures.com
Click on EMET on left to access presentations provided.
Registrar education sessions and interesting education links