76M with Hx of MI feels unwell

Differential for Wide Complex Tachycardia

1.

2.

3.

4.

5.

Differential for Wide Complex Tachycardia

1. VT

2. SVT with Bundle Branch Block

3. Pacemaker

4. WPW

5. Artifact

Differentiating VT from SVT with BBB

Do they have a history of ischemic heart disease?

>90% Pretest Probability of VT

Does it look like a typical BBB

R>R' = VT

Typical RBBB

Does it look like a typical BBB

Typical LBBB: Dominant steep S wave V1, Wide R wave V6

Weird, doesn't look like anything

Positive or negative concordance

Extreme Axis (RBBB axis = N, LBBB axis = L)

Fusion Beats or Capture Beats

AV Dissociation

24F history of lupus

Differential of Deeply Inverted T waves

1.

2.

3.

4.

Massive PE with RV Strain

Differential of Deeply Inverted T waves

1. RV strain

2. Wellens

3. Ischemia

4. Neuro

Wellens Type A

Wellens Type B

Regularized Afib

1. Dig Tox
2. Afib with CHB

Temp Wire?

56M with chest pain

Pericarditis

• Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).
• Reciprocal ST depression and PR elevation in lead aVR (± V1).

Treatment

• NSAIDS 2-4 weeks
• Colchicine 3 months

62M with chest pain

Posterior MI is suggested by the following changes in V1-3:

• Horizontal ST depression
• Tall, broad R waves (>30ms)
• Upright T waves
• Dominant R wave (R/S ratio > 1) in V2

Posterior infarction is confirmed by the presence of ST elevation and Q waves in the posterior leads (V7-9).

Complications of Inf MI

1. Complete Heart Block, Bradycardia
2. Acute MR
3. RV involvement (preload dependent cannot use nitro) look for ST elevation in V1 or V4R

36F from Sudan, just moved here from Calgary, new start dialysis

Classic Stages of Hyperkalemia

• Peaked T waves
• Prolongation of PR interval
• Widening QRS Complex
• Loss of P wave
• “Sine Wave”
• Asystole

BP 70/40, somnolent, dx/tx?

BP 120/70, smiling, dx/tx?

How do you push

adenosine?

SVT Differential?

AV Dependent

1. AVNRT
2. AVRT

AV Independent

1. Sinus Tachycardia
2. Atrial Tachycardia
3. Multifocal Atrial Tach
4. Atrial fibrillation
5. Atrial Flutter