ECG QUIZPROF(DR).G.SUNDARAMURTHYM2 UNITDR.DILIP HARINDRANSECOND YEAR PG RESIDENT

PRESENTATION

• A 73 YEAR OLD MALE CAME WITH COMPLAINTS OF DIFFICULTY IN USING LEFT UPPER LIMB AND LOWER LIMB SINCE MORNING. A KNOWN DIABETIC AND HYPERTENSIVE.

• O/E PR - 64/MIN, BP - 160/100 MM HG, GCS -8/15 CNS - LEFT HEMIPLEGIA.

• ECG WAS TAKEN FOR THE PATIENT WHICH SHOWED,

INTERPRETATION• NORMAL SINUS RHYTHM• RATE - 75/MIN• P WAVE - NORMAL MORPHOLOGY, REDUCED

VOLTAGE IN LIMB LEADS• PR INTERVAL NORMAL• QRS COMPLEX NORMAL MORPHOLOGY, LOW

VOLTAGE IN LIMB LEADS• QT INTERVAL PROLONGED - 500MS AND DEEP

ANTEROLATERAL T WAVE INVERSIONS (CAN BE DUE TO CNS INVOLVEMENT OR MYOCARDIAL ISCHEMIA).

DISCUSSION

• ECG FINDINGS OF ACUTE CNS DISORDERS INCLUDE:

1. LARGE UPRIGHT T WAVES IN PRECORDIAL LEADS

2. INCREASED QRS VOLTAGE3. DEEPLY INVERTED T WAVES IN PRECORDIAL

LEADS4. PROLONGED QT INTERVAL5. PROMINENT U WAVES IN PRECORDIAL LEADS

• OTHERS FINDINGS INCLUDE:1. T WAVE NOTCHING2. LOSS T WAVE AMPLITUDE3. DIFFUSE ST SEGMENT ELEVATION4. ABNORMAL Q WAVES5. RHYTHM ABNORMALITIES LIKE AF, VT, SINUS

BRADYCARDIA OR TACHYCARDIA CAN OCCUR.

• ECG CHANGES ASSOCIATED WITH ACUTE CNS EVENTS CAN MIMIC -

1. ACUTE MYOCARDIAL INFARCTION2. LEFT VENTRICULAR HYPERTROPHY3. RIGHT VENTRICULAR HYPERTROPHY4. PERICARDITIS5. ANTIARRHYTHMIC DRUG EFFCTS

FIND THE IMPOSTER

ANSWER• TRACINGS A, B AND C SHOW ATRIAL FIBRILLATION

WITH IRREGULARLY IRREGULAR RHYTHMS; FIBRILLATORY WAVES OF VARYING AMPLITUDE AND MORPHOLOGY; ABSENCE OF DISCRETE P WAVES.

• TRACING D SHOWS MAT. IT USUALLY PRESENTS WITH ATRIAL RATE OF >100BPM, 3 OR MORE DIFFERENT P WAVE MORPHOLOGIES, AND VARYING PP AND PR INTERVAL. DEFINITE P WAVES AND ATRIAL DEPOLARIZATIONS ARE NOTED WHICH ARE NOT THERE IN A, B AND C.

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