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Tuesday, 18 November 2014

#ECGclass - Autumn Term 4 - Q6&7

Welcome! 

If you are new to ECGclass, before we start, you may like to read this brief explanation of what it's all about:  #ECGclass and how it works
Each 'term' is spilt into 5 cases launched a 2 weekly intervals.  

So here goes with the next case of this term!


Autumn Term - Case 4 

Back to the GP consulting room again today…..

This 44yrs man comes to see you, his GP, on Monday morning. 

He explains that he was taken to A&E after a sudden collapse and hit his head at a party on Saturday evening. By the  time the paramedics arrived he had already regained conciousness but was taken to A&E as a precaution. 

At A&E he recalls that he had bloods taken, an ECG and a CT head scan. 
He was advised that all investigations were normal and that his head transient loss of conciousness was thought to be 'alcohol induced'.  
At the time, he protested that he hadn't had excessive alcohol intake that evening (in fact, very little) and so the suggestion was made that perhaps his drink had been spiked, or that he'd reacted badly to combining alcohol with his antidepressant medication.

He remains unreassured, and tells you that this was a small 'family gathering', to celebtate his grandparents diamond wedding anniversary. He feels it extremely unlikely that his drink was spiked, and he has drunk alcohol on previous occasions with his medication without any adverse effects. 
Since that evening, he has felt fine, but remains very worried about the cause of his collapse. 

You examine him and find his BP is 106/64, his heart sounds are normal. Pulse is strong and regular. His lung fields are clear. 

He has no personal past history of palpitations, or chest pain; and no family history of cardiac problems.  His only medication is low dose of citalopram, which he has taken since his marriage breakdown a year ago. 

You check on the hospital ICE/pathlinks and note the normal CT scan along with the normal FBC, glucose,  thyroid, LFTs and U&Es but agree to perform another ECG in view of his ongoing concern.



Q1. What possible diagnoses are you thinking about whilst you await his ECG? 



He arrives back in yout room the ECG below: 




What does it show?
Let's analyse the ECG methodically to get the answer….



Q2.        What is the rate and rhythm?

Q3.         Is the axis normal?


So now let's look at all the intervals:

Q4.        Is the PR interval normal? 
        
Q5.        Is the conduction through the QRS rapid and normal, or delayed?  
        


Q6.        What about the QT interval? 

Q7        Does the QT interval need correcting? (ie QTc)



DON'T FORGET THE HASHTAG!
Please use the hashtag #ECGclass if joining in the live and interactive conversation Twitter
and...If you want to ask the patient any questions, or request any further investigations this can  be done by the hashtag during the course of this evening. 

Alternatively, if referring to this blog at a later date, please leave comments below.
Thank you.

***

Discussion/update later/see next blog post once available

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