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Monday, 4 February 2013

#ECG class Case 23

#ECG Class is an educational blog which runs alongside Twitter.
A new ECG "quizz" is launched most Monday evenings, in term time. 
Cases are generally aimed at Primary Care. 
All scenarios are completely fictitious and theoretical, but based on commonly occurring presentations in General Practice. 
This is an educational site, intended for healthcare professionals and shouldn't be construed as patient advice. 

Please use the Hashtag #ECGclass on Twitter, if you want to ask the patient any questions, or request any further investigations. Alternatively, please join in discussion and leave comments below.

Remember there are no right or wrong answers!  

ECG interpretation is often open to debate, and will usually evolve and change as new information becomes available.  Everyone's opinion is valid, and useful for others, as the evolution process takes place. Together we will try and form an interpretation based on the trace, and information, we have in front of us.  Don't worry if you disagree - shout up and share your thoughts - the diagnosis is often arguable on the basis of a 12 lead trace, and may only become more obvious when a longer rhythm strip is available. 

Please feel free to join in, but most important of all, have fun! :-)

#ECGclass Case 23 

A 64yr old lady comes to see you, complaining of breathlessness on minimal exertion over the past 6months. She denies any chest tightness or discomfort.
She has no past cardiac history, and has always enjoyed a healthy lifestyle.
She takes no medication.

Examination in unremarkable.  She appears slim and healthy, is normotensive, with a regular pulse rate of 80 bpm, and no murmurs.

You arrange some routine bloods, which are normal, and an ECG.  Her serum BNP comes back at 38.

Her ECG is below. The digital ECG machine interpretation reports :

  • Sinus rhythm
  • Multifocal ventricular extrasystoles
  • Run of ventricular extrasystole
  • Inferior myocardial infarct, age undetermined.

What do you think?
Lets take each of these statements in turn.

Q1.  Is this sinus rhythm? (Can you see P waves, and if so are they regular and associated with every QRS?)

Q2. Can you see the multifocal ventricular extrasystoles, or the run of ventricular extrasystoles?

Q3.  Is this ECG consistent with an Inferior MI? 

When you've had a go,  you'll find the full discussion on the next blog!

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