A 78-year-old woman presents to the emergency department with an 2-week history of shortness of breath on exertion. Describe and interpret her initial 12-lead electrocardiogram: The post ECG #49 appeared first on EM Blast ..read more

A 49-year-old man presents to the emergency department with an 18-hour history of bilateral jaw pain, increasing over the past few hours with associated chest tightness. Describe and interpret his initial 12-lead electrocardiogram: Show solution   DESCRIPTION: Sinus rhythm with a ventricular rate of 69 bpm Normal PR interval (142 ms) Normal QRS axis (8°) Borderling prolongued QRS duration (102 ms) Poor R wave progression Subtle ST-segment elevation in the inferior lead (II, III & aVF) Subtle reciprocal downsloping ST-segment depression in lead aVL INTERPRETATION: Inferior ST ..read more

A 13-year-old boy presents to the emergency department with central pleuritic chest pain, worse on exertion and associated with a recent viral prodrome. Describe and interpret his initial 12-lead electrocardiogram: Show solution   DESCRIPTION: Sinus rhythm with a ventricular rate of 90 bpm Normal PR interval (110 ms) Normal QRS axis (70°) Normal QRS duration (86 ms) Normal R wave progression Widespread concave ST-segment  elevation throughout the precordial leads (V1-6) and limb leads (I, II, III and aVF) with associated PR-segment depression and down-sloping TP segments (“Spodick ..read more

An 83-year-old woman presents to the emergency department reporting a 3-hour history of central pleuritic chest pain, onset at rest, with associated dyspnoea and diaphoresis. Describe and interpret her initial 12-lead electrocardiogram: Show solution   DESCRIPTION: Sinus rhythm with a ventricular rate of 88 bpm Normal PR interval (194 ms) Normal QRS axis (-11°) Normal QRS duration (82 ms) Normal R wave progression Widespread ST-segment/J-point  elevation (V2-6, I, II, aVL) with associated broad-based hyperacute T-waves ST-segment depression with associated T-wave inversion lead II ..read more

A 17-month-old boy is brought into the emergency department by his mother reporting intermittent fevers and coryzal symptoms over the past few weeks, with signs of increased irritability and work of breathing over the past 12-hours. Describe and interpret the following radiographs (click on images to enlarge): Show solution Severe right-sided pneumonia: predominantly involving the right upper and lower lobes patchy infiltrate in the middle lobe Large parapneumonic effusion Generalised bronchial wall thickening bilaterally Possible left-sided mild perihilar consolidation Leftward mediast ..read more

An 83-year-old man presents to the emergency department with a 3-week history of right-sided shoulder/scapula pain. Describe and interpret his initial 12-lead electrocardiogram: Show solution   DESCRIPTION: Sinus rhythm with a ventricular rate of 79 bpm PR interval 166 ms Normal QRS axis (-29°) Normal QRS duration (89 ms) Loss of R wave progression Convex ST-segment elevation throughout the precordial leads (V1-5) with associated T-wave inversion ST-segment depression in high lateral leads (I aVL) and V6 with associated T-wave inversion INTERPRETATION: Anterior ST-Elevation Myocardia ..read more

A 57-year-old man presents to the emergency department with a 3-day history of increasing dyspnoea and pre-syncopal symptoms. Describe and interpret his initial 12-lead electrocardiogram: Show solution   DESCRIPTION: Ventricular rate 127 bpm Irregularly irregular rhythm with no discernible P waves Northwest QRS axis (249°) Prolonged QRS duration (128 ms) Beats 11 through 13: broad complex tachycardia (150 bpm) with different morphology to remainder of ECG INTERPRETATION: Atrial fibrillation with aberrant conduction Fast ventricular response Non-sustained episodes of ventricular tachy ..read more

A 10-day-old baby girl presents to the emergency department with a history of poor feeding and lethargy. Describe and interpret her initial 12-lead electrocardiogram: Show solution DESCRIPTION: Narrow complex (QRS duration 46 ms) tachycardia (ventricular rate 313 bpm) No obvious P-waves Rightward QRS axis (130°) ST-segment depression throughout the precordial leads T-wave inversion in the inferior leads (II, III, aVF) INTERPRETATION: Supraventricular tachycardia CASE RESOLUTION: Initial application of ice packs to the face failed to terminate the SVT. Restitution of normal sinus rhyt ..read more

A 27-year-old woman presents to the emergency department with a history of intermittent palpitations. Describe and interpret her initial 12-lead electrocardiogram: Show solution DESCRIPTION: Sinus rhythm (ventricular rate 79 bpm) Very short PR interval (114 ms) Normal QRS axis (15°) Prolonged QRS duration (124 ms) Slurred upstroke to the QRS complexes Dominant S wave in V1 ST-segment elevation with negative delta waves in leads III and aVF ST-segment depression with subtle biphasic T wave inversion in leads I and aVL Prolonged QTc interval 474 ms INTERPRETATION: Wolff-Parkinson-White ..read more

A 22-year-old man presents to the emergency department reporting a 3-day history of dull left-sided chest discomfort on a background of recent upper respiratory tract infection. Describe and interpret his initial 12-lead electrocardiogram: Show solution DESCRIPTION: Ventricular rate 116 bpm Sinus rhythm/tachycardia Normal PR interval 162 ms Normal QRS axis (86°) Prolonged QRS duration 114 ms Prominent coved ST-segment elevation ≥2 mm in V1 and V2, followed by negative T waves Coved ST/J-point elevation also present in aVL and aVR ST-segment depression and T wave inversion in II, III, and aV ..read more