ECG Rounds

Description

Cover Title Copyright Contents by Difficulty Level Contents by Subject Matter Contributors Foreword Preface Introduction Section I Level 1 Case #1. A 47-year-old man presenting for preoperative evaluation prior to knee arthroscopy Case #2. An asymptomatic 56-year-old gentleman presents for routine follow-up Case #3. A 43-year-old asymptomatic man Case #4. A 65-year-old woman complaining of 3 hours of severe epigastric “bloating.” Case #5. A 68-year-old male with a history of diet-controlled diabetes and well-controlled hypertension presents for follow-up Case #6. A 74-year-old gentleman with distant history of myocardial infarction presents for routine follow-up Case #7. A 63-year-old lifelong smoker presents with dyspnea and diffuse wheezes Case #8. A 44-year-old obese woman presents with fever and right upper quadrant abdominal pain that began after a meal at a fast-food restaurant Case #9. A 54-year-old gentleman presents with chest discomfort. He had rhinorrhea and cough 1 week ago Case #10. A 56-year-old woman with word-finding difficulty and hand weakness Case #11. A 42-year-old gentleman presents with palpitations Case #12. A 47-year-old man with chest pain and shock Case #13. An 80-year-old male presents with syncope. On examination, a late-peaking, crescendo-decrescendo systolic murmur is heard Case #14. A 64-year-old woman abruptly loses consciousness and is found to be pulseless. After successful defibrillation, the following ECG is recorded Case #15. A 38-year-old woman with chest pain Case #16. A 75-year-old woman with a history of stroke Case #17. A healthy 26-year-old medical student has an ECG performed as part of his physical diagnosis class. He is asymptomatic Case #18. A 51-year-old gentleman presents to his primary care physician for a yearly physical exam. He is asymptomatic Case #19. A 65-year-old man with hypertension and chronic kidney disease presents with presyncope Case #20. A 34-year-old woman presents with syncope. She has no medical history except for 3 miscarriages in the past Case #21. A 42-year-old gentleman status post radiofrequency ablation for paroxysmal atrial fibrillation Case #22. A 72-year-old woman with hypertension and mitral regurgitation is seen in follow-up Case #23. A 68-year-old woman presents to her primary care physician. She has a history of remote myocardial infarction and congestive heart failure Case #24. A 28-year-old cross-country runner has the following ECG obtained Case #25. A 42-year-old woman presents with chest fluttering Case #26. A 65-year-old with a history of nonischemic cardiomyopathy presenting after a shock from his implantable defibrillator Case #27. An 18-year-old young man presents with nausea after cocaine use Case #28. A 79-year-old female presents with dizziness and abdominal pain Case #29. A 24-year-old presents with pleuritic chest pain Case #30. A 65-year-old woman with hypertension presents for routine primary care follow-up Case #31. A 62-year-old male presents with palpitations and breathlessness Case #32. A 68-year-old gentleman presents with chest pain Case #33. A 42-year-old woman with 2 months of palpitations and exertional dyspnea. She has a distant history of rheumatic fever Case #34. A 61-year-old man presents for follow-up Case #35. A 65-year-old woman with poorly controlled hypertension presenting for routine office follow-up Case #36. A 59-year-old gentleman presents with 20 minutes of substernal chest pain that abated spontaneously Case #37. A 62-year-old gentleman transferred for further management of ST elevation MI Case #38. A 74-year-old woman with paroxysmal atrial fibrillation maintained on digoxin Case #39. An 81-year-old woman with COPD presents for follow-up Case #40. A 63-year-old man with hypertension appreciates “skipped beats” when measuring his radial pulse Case #41. A 48-year-old gentleman presents with dyspnea. A diastolic rumbling murmur is heard over the cardiac apex Case #42. A 56-year-old gentleman with end-stage renal disease presents with nausea after missing a dialysis treatment Case #43. A 62-year-old gentleman with chest pain Case #44. A 62-year-old male complains of a racing heart Case #45. A 45-year-old woman undergoing chemotherapy for lymphoma presents with chest pain, cough, and hypoxemia Case #46. A 33-year-old gentleman with familial hypercholesterolemia presenting with 28 hours of ongoing severe jaw pain and vomiting Case #47. A 46-year-old man with chest pain and rhinorrhea Case #48. A 78-year-old man presents with substernal chest pain at rest Case #49. An 83-year-old woman with severe chronic obstructive pulmonary disease is admitted to the hospital with community-acquired pneumonia Case #50. A 48-year-old woman with diabetes and smoking history presents with nausea, diaphoresis, and upper epigastric discomfort Section II Level 2 Case #51. An asymptomatic 30-year-old woman Case #52. A 53-year-old woman with long-standing mitral valve prolapse Case #53. An 89-year-old gentleman with hypertension, presenting for routine follow-up Case #54. A 68-year-old patient post-op from thyroidectomy presents with muscle cramps; Chvostek’s and Trousseau’s signs are noted on examination Case #55. A 67-year-old smoker presents with chest pain and palpitations on postoperative day 2 after cholecystectomy Case #56. An 18-year-old woman with a “seizure disorder” diagnosed in childhood, who has been event-free on phenytoin Case #57. A 45-year-old gentleman presents with dyspnea Case #58. A 74-year-old woman with a distant history of rheumatic fever presents with dyspnea, hemoptysis, palpitations, and a murmur Case #59. A 70-year-old gentleman with history of distant myocardial infarction and systolic dysfunction complaining of palpitations and dizziness Case #60. A 56-year-old man presents to a small community hospital with severe left shoulder and arm pain. There is no catheterization lab on site Case #61. A 23-year-old man presents with “neck pounding” that occurs without warning about once each month Case #62. A 21-year-old runner presents for a preparticipation physical examination. This ECG is obtained because of an irregular heart rhythm Case #63. A 47-year-old woman presents to the emergency department with palpitations and the initial ECG. Carotid sinus massage is performed, after which the second ECG is recorded Case #64. A 76-year-old man with a history of coronary disease presents with palpitations Case #65. A 22-year-old young woman with profound weight loss and poor oral intake Case #66. A 72-year-old woman presents for routine follow-up Case #67. A 67-year-old man presents with 2 days of dizziness and lightheadedness Case #68. A 60-year-old man with diabetes presents with increasing lower-extremity edema and effort intolerance Case #69. A 70-year-old woman with known multiple myeloma presents with increasing fatigue and confusion. Two tracings are shown Case #70. A 58-year-old woman presents with a syndrome of alcohol withdrawal Case #71. An 82-year-old woman presents with fatigue and syncope Case #72. A 52-year-old man with no history of previous medical care presents with hypothermia, somnolence, and an abnormal deep tendon reflex Case #73. A 79-year-old gentleman presents with 1 hour of chest pain and an episode of syncope Case #74. You are asked to see this 73-year-old hospitalized patient for evaluation of a new arrhythmia Case #75. A 27-year-old gentleman with fever and rash after a camping trip Case #76. A 44-year-old man with a long history of substance abuse used cocaine 2 days prior and presents with 48 hours of unremitting chest pain Case #77. An 82-year-old woman presents with syncope and chest pain. She has a distant history of myocardial infarction Case #78. A 56-year-old businessman presents with hemoptysis and pleuritic chest pain after returning to Boston from a conference in China Case #79. A 44-year-old man presents with palpitations Case #80. A 55-year-old woman with nonischemic cardiomyopathy presents with this wide complex tachycardia Case #81. A 53-year-old female with shortness of breath presents to her cardiologist. She has a loud second heart sound on examination Case #82. A 77-year-old woman with atrial fibrillation presents with 3 days of fatigue. She is on no AV nodal blocking medications Case #83. A 31-year-old female with a family history of sudden cardiac death of a brother and a maternal aunt Case #84. A 55-year-old presents with chest pain, dyspnea, and hypotension Case #85. An asymptomatic 79-year-old man Case #86. A 48-year-old female presents to her physician after experiencing an episode of lightheadedness and palpitations at home. A resting ECG is shown below Case #87. A 27-year-old woman complaining of a racing heart Case #88. A 63-year-old gentleman 4 days after cardiac surgery Case #89. A 53-year-old woman presents with cardiogenic shock after a recent upper respiratory infection. Coronary angiography demonstrates no coronary disease Case #90. A 45-year-old patient with nonischemic cardiomyopathy presents with dizziness and lethargy after an increase in his furosemide dose Case #91. An 85-year-old man presents with 45 minutes of severe breathlessness Case #92. A 55-year-old man with a history of atrial fibrillation and pacemaker placement presents for follow-up Case #93. An 83-year-old female presents to the emergency department after 2 syncopal episodes at home Case #94. An asymptomatic 55-year-old man with a new abnormality on his ECG Case #95. A 56-year-old woman presents with cardiac arrest, defibrillated in the field by EMS. Two tracings on arrival to the ED are shown Case #96. A 59-year-old woman presents to the office complaining of depression and confusion Case #97. A 78-year-old man with poorly controlled hypertension presents with worsening dyspnea on exertion Case #98. A 57-year-old gentleman with nonischemic cardiomyopathy presents with sudden onset of extreme fatigue, malaise, and dizziness Case #99. A 67-year-old woman presents for follow-up Case #100. A 70-year-old woman with known right bundle branch block presenting with dyspnea and nausea Section III Level 3 Case #101. A 68-year-old male presents with several days of fatigue and palpitations Case #102. This 46-year-old patient has night sweats, a cough, and an abnormal cardiac contour on chest radiograph Case #103. A 74-year-old woman presents with dizziness Case #104. A 56-year-old patient with end-stage renal disease is found obtunded after missing several dialysis treatments Case #105. A 75-year-old woman presents with breathlessness, nausea, and left arm pain. Her history is notable for left bundle branch block and dyslipidemia Case #106. An 87-year-old woman presents with multiple episodes of near-syncope while doing housework Case #107. A 37-year-old man with syncope Case #108. A 66-year-old man presents with a complaint of “heart pounding.” Two tracings from presentation with the patient’s baseline tracing are shown Case #109. A 35-year-old woman with prior history of malignancy treated with adriamycin presents for follow-up Case #110. A 70-year-old gentleman with ischemic cardiomyopathy treated with implantable cardioverter-defibrillator (ICD) placement presents with several ICD discharges. While a 12-lead ECG is being recorded, this event transpires Case #111. A 67-year-old man with a heavy tobacco use history admitted to the ICU with respiratory failure Case #112. A 54-year-old hospitalized patient Case #113. A 77-year-old gentleman presents with dizziness and dyspnea at rest Case #114. The 77-year-old man from the prior case now status post an intervention Case #115. A 78-year-old man with chest pressure and dyspnea requiring inotropic therapy Case #116. The same 78-year-old gentleman, now with this rhythm Case #117. A 50-year-old male without cardiac history has an ECG prior to an elective inguinal hernia repair Case #118. A 76-year-old woman with metastatic breast cancer presents with dyspnea. The presentation and baseline tracings are shown Case #119. An 85-year-old woman complains of “skipped beats.” Case #120. A 65-year-old man with history of an anterior MI in the distant past presents with palpitations Case #121. A 35-year-old woman found down in a snowstorm Case #122. A 79-year-old woman presents with syncope Case #123. An 82-year-old woman admitted to the intensive care unit with sepsis, yesterday initiated on haloperidol for agitation, now with these tracings Case #124. A 22-year-old patient with complex cyanotic congenital heart disease seen in follow-up Case #125. An 18-year-old man with weakness Case #126. A 78-year-old gentleman with a history of coronary artery disease presents with 30 seconds of left-hand weakness consistent with transient ischemic attack Case #127. A 55-year-old man undergoing therapeutic hypothermia after cardiac arrest Case #128. A 67-year-old woman presents with palpitations Case #129. A 22-year-old asymptomatic woman with a family history of sudden unexplained death Case #130. A 38-year-old gentleman presents with progressive dyspnea on exertion for the past 6 months Case #131. A 66-year-old woman presents with syncope and has a procedure performed Case #132. A 77-year-old patient with known rheumatic mitral stenosis, maintained on digoxin, presents with palpitations Case #133. A 62-year-old man presents with cardiac arrest. Tracings pre and post defibrillation are shown Case #134. A 66-year-old man presents with syncope and a fall Case #135. A 73-year-old man underwent a cardiac procedure Case #136. A 76-year-old patient with chronic kidney disease presents with cardiac arrest Case #137. A 42-year-old gentleman with poorly controlled diabetes presents with stuttering chest pain for up to 15 minutes at a time over 24 hours. He is pain-free at the time of this ECG Case #138. A 32-year-old male presents with syncope Case #139. An 85-year-old male post-op from coronary artery bypass grafting maintained on dobutamine. His ECG is below Case #140. A 59-year-old male with hypertension presents to the emergency department with 2 episodes of syncope Case #141. A 23-year-old with a history of syncope. Two tracings are shown Case #142. A 76-year-old woman presenting with vomiting and upper epigastric “pressure” coupled with “heart fl uttering.” Case #143. An 89-year-old woman with intermittent palpitations and dizziness Case #144. A 49-year-old woman presents with cardiac arrest. On examination, warm, dry, fl ushed skin, and dilated pupils are noted Case #145. A 64-year-old woman presents with dizziness Case #146. A 75-year-old man presents with crushing substernal chest pain, syncope, and a sense of impending doom Case #147. A 42-year-old woman with a history of rheumatic mitral stenosis presents with palpitations Case #148. A 56-year-old gentleman presented with chest pain and ST-segment elevation myocardial infarction and is now status post successful treatment with thrombolytic medications. As his chest pain is resolving, he has this arrhythmia Case #149. A 36-year-old woman presents with syncope Case #150. A 55-year-old gentleman presents with 10 minutes of crushing substernal chest pressure Index