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  1. What do you think the chief complaint is? [464 ECG]

    What do you think the chief complaint is?
    Dyspnea/cor pulmonale

    Question: 64-year-old male: what do you think his chief complaint is? * * * Difficulty rating
    Answer: Dyspnea. The ECG shows evidence of right ventricular (RV) overload with 1) sinus tachycardia; 2) right axis deviation, with the classic S1Q3T3 pattern; 3) incomplete right bundle branch block (RBBB) with RSR' (or qR) in V1 and S waves in lateral ...
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  2. What's the diagnosis? [464 ECG]

    What's the diagnosis?
    Hyperkalemia

    Question: This ECG is most consistent with: * * Difficulty rating
    a) Acute anterior myocardial infarction (MI)
    b) Pericarditis/tamponade
    c) Chronic renal failure
    d) Tricyclic antidepressant overdose
    e) Myxedema coma
    Answer: c) There is classic evidence of hyperkalemia with tall, narrow T waves, most evident in leads V3-V4, along with QRS prolongation ...
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  3. What was the patient recently treated for with a drug? [464 ECG]

    What was the patient recently treated for with a drug?
    Drug-related QT prolongation

    Question: What intermittent arrhythmia do you think this 76-year-old woman was recently treated for with a drug? There are two major ECG clues. * * * Difficulty rating
    Answer: Atrial Fibrillation. The rhythm is now sinus, with borderline sinus bradyardia, at about 60/min Note: 1) The wide notched P wave in lead II and biphasic ...
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  4. 55-yr-old male with chest discomfort [464 ECG]

    55-yr-old male with chest discomfort
    Post-op pericarditis

    Question: 55-yr-old male with chest discomfort 5 days post "coronary artery bypass graft (CABG) surgery". * * * Difficulty rating
    Answer: ECG shows classic findings of acute pericarditis. Note diffuse ST elevations (leads I, II, aVL, aVF, V3-V6) with concomitant PR segment deviations (PR up in lead aVR, down in II, V4-V6). Thus, ST and PR injury ...
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  5. What's the diagnosis? [464 ECG]

    What's the diagnosis?
    Hyperkalemia

    Question: 66-yr-old male: what evidence (subtle) is there that he has chronic renal failure? * * * * Difficulty rating
    Answer: The tracing shows sinus rhythm with a prolonged PR interval, intraventricular conduction defect (IVCD), left atrial abnormality (LAA), probably underlying left ventricular hypertrophy (LVH) and probably underlying anteroseptal
    myocardial infraction ...
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  6. 52-yr-old male with weakness. [464 ECG]

    52-yr-old male with weakness.
    Acute infero-postero-lateral infarction

    Question: 52-yr-old male with weakness. * * * Difficulty rating
    Answer: Acute infero-postero-lateral myocardial infarction (MI). Note reciprocal ST depressions in V1-V3, with primary, (hyper) acute ST elevations/relatively prominent T waves inferiorly and laterally. If you called anterior subendocardial ischemia, look again at the subtle changes ...
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  7. What is the rhythm? [464 ECG]

    What is the rhythm?
    Atrial tachycardia with block

    Question: 92-year-old female. What is the rhythm? * * Difficulty rating
    Answer: Atrial tachycardia with 2:1 block and ventricular premature complexes (VPBs). Check out lead V1 if you missed this. The atrial rate is 200. (Points against atrial flutter are the atrial rate and discrete-appearing P waves, upright in lead 2). Also present: left ventricular hypertrophy ...
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  8. 55-yr-old male with "new onset atrial flutter." [464 ECG]

    55-yr-old male with "new onset atrial flutter."
    Sinus rhythm with artifact

    Question: 55-yr-old male. The "call-in diagnosis is "new onset atrial flutter." * * * Difficulty rating
    a) Atrial flutter with 4:1 AV block
    b) Coarse atrial fibrillation with a regularized ventricular response
    c) Atrial tachycardia (unifocal) with block
    d) Sinus rhythm with artifact
    e) ...
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  9. What is the diagnosis? [464 ECG]

    What is the diagnosis?
    Rheumatic heart disease with severe mitral stenosis

    Question: 52-year-old female. ECG is most consistent with ? * * * Difficulty rating
    a) Severe aortic insufficiency
    b) Coronary artery disease with prior inferior-posterior myocardial infarction
    c) Rheumatic heart disease with severe mitral stenosis
    d) Acute pulmonary embolism
    e) Apical hypertrophic cardiomyopathy ...
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  10. What's going on here? [464 ECG]

    What's going on here?
    Acute anterior myocardial infarction

    Question: 34-year-old male. What's going on here? * Difficulty rating
    Answer: ECG shows classic findings of acute/hyperacute anterior wall Q wave myocardial infarction (MI), with reciprocal inferior ST depressions. The distribution of changes is consistent with a proximal left anterior descending (LAD) occlusion which was confirmed at cardiac catheterization ...
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