Quiz #40: EKG

EKG from a 1-day old newborn is given. Patient was consulted by NICU for "bradycardia" (~90 bpm). Clue: V1 rhythm strip provides good wave form to evaluate.

Questions:
1) What is the cause of the relative "bradycardia"?
2) Explain why A-V block is not the primary diagnosis.

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Quiz #38: EKG: What is the rhythm diagnosis?

5-mo old with Down Syndrome. 2nd postoperative day after surgical closure of large inlet VSD.

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Quiz #36: EKG

12-lead EKG is provided. What is the diagnosis?

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Quiz #34: ICU - Temporary Pacemaker

Quiz # X: ICU – Temporary Pacemaker

6 month old infant s/p AV septal defect repair. 3^rd postoperative day. Underlying rhythm was 3^rd degree AV block & probable sinus node dysfunction. The rhythm strip was printed to evaluate the temporary pacemaker.

Questions:

1) What mode is being used?

2) Comment on the following:

a.       Is the pacemaker atrial pacing properly? (Yes/No)

b.      Is the pacemaker atrial sensing properly? (Yes/No)

c.       Is the pacemaker ventricular pacing properly? (Yes/No)

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Quiz #30: EKG - Arrhythmia

13-year old girl was transferred to Pediatric ICU for atrial flutter. She is obtunded and has muscle tremors. Suspected to have developed encephalopathy as part of a systemic vasculitis. Figure 1 is an strip from floor with EKG and pulse oximeter trace. Figure 2 is an apical 4-chamber view with Doppler trace of mitral/aortic valve flows.

Questions:
1) What is the diagnosis?
2) How will you manage?

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Quiz #28: EKG

Quiz #28: EKG

3 year old, post-op day 1.

1)      What is the ventricular rate? (Note: Paper speed).

2)      What is the atrial rate?

3)      What is the diagnosis?

4)      In the past 4 hrs patient has become hypotensive with lower urine output and needed multiple fluid boluses and increase in Dopamine dose. What is the first line treatment?

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Quiz #27: EKGs on the day of surgery

6 yr old boy, s/p Repair of subaortic membrane. Two EKGs with time of recording are given - both were recorded on the day of surgery. Second EKG was performed because bedside nurse noted a change in EKG trace on the monitor. Patient is sleeping without any complaints.

Questions:

1) Describe the most significant change between the two EKGs.

2) What are the possible reasons for change?
3) How would you proceed further?

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Click on the image to enlarge.

EKG 1: Recorded at 12:44 Hrs

EKG 2: Recorded at 22:44 Hrs. 

Quiz #21: EKG

EKG (15-leads and Rhythm strip) is provided from a 11-yr old girl. Referred for sports clearance and family history of heart disease (Grand parents developed coronary artery disease in their 60s). Physical exam is normal.

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Quiz #18: EKG Rhythm Strip

This is an EKG recorded in a 2-day baby (Tetralogy of Fallot) after cardiac catheterization.

Question: What is this catheter-induced rhythm?

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Quiz #15: 12-lead EKG - Inverted P

Question: What is the diagnosis for the inverted P?

(Clue: You may compare with the EKG in Quiz #14)

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Quiz #14: 12-lead EKG

Question 1: What is the diagnosis?

Question 2: Please provide 2 salient findings that support the diagnosis.

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Quiz #5: EKG (12-lead)

Sinus rhythm EKG from a 17-year old patient:
1) What is the diagnosis? (Answer is obvious, of course!)
2) Where is the accessory pathway located?
(Click on the image to see a larger image)

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Quiz #4: EKG - Pacemaker

4 month old, s/p VSD repair. Postoperative day #3. Temporary pacemaker is on, for complete AV block. Set to DDD mode. What is wrong?

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