Moderator EMEDPA Posted July 11, 2009 Moderator Share Posted July 11, 2009 identify the following ekg finding and the xray finding pictured below. hint: the ekg finding can be made just with the leads pictured. both pts seen today within 1 hr of each other. xr1.bmp xr2.bmp xr3.bmp coolekg.bmp Quote Link to comment Share on other sites More sharing options...
dfwpa Posted July 11, 2009 Share Posted July 11, 2009 For some reason, the thumbnails aren't enlarging when I click on them, but it looks like some ST seg. elevation in the septal leads....so I'm guessing septal infarct....nice to see the rest to look for any reciprocal changes....the xray is much harder to read being so small...looks like a FB is all I can say Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2009 Author Moderator Share Posted July 11, 2009 For some reason, the thumbnails aren't enlarging when I click on them, but it looks like some ST seg. elevation in the septal leads....so I'm guessing septal infarct....nice to see the rest to look for any reciprocal changes....the xray is much harder to read being so small...looks like a FB is all I can say not a fb... you don't need to see the whole ekg for this dx only leads v1 and v2. Quote Link to comment Share on other sites More sharing options...
Febrifuge Posted July 11, 2009 Share Posted July 11, 2009 On the EKG, I see flipped T waves in V1 and V2. I'm also not sure if I'm seeing P waves at all, which is especially weird considering the rate around 100. The QRS could also be a little tight. As to what causes that... well, I'm a new grad. I have some street smarts but need practice to see the forest for all these trees. Of course, we know nothing about history, presentation, or exam (but what would be the fun in that, right?) The xray is gnarly. I can't figure out what is being avulsed here, as that radio-opaque lump is a fair distance from anywhere that might be normal anatomic position (for a chunk of distal radius, say, and that goes double for a carpal bone). Maybe a calcification where there had been an old injury? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 11, 2009 Author Moderator Share Posted July 11, 2009 see this link for info on the ekg finding: http://en.wikipedia.org/wiki/Brugada_syndrome this particular ekg goes along with a woman who had chest pain followed by syncope. she ended up with an AICD. that "radio-opaque lump" is one of the carpal bones-the lunate in fact. worst dislocation any of us had every seen. elderly guy fell forward striking his palmar surface and volar wrist on the ground. yes, it required a surgical repair..... Quote Link to comment Share on other sites More sharing options...
Febrifuge Posted July 12, 2009 Share Posted July 12, 2009 Dang, I should have gone with my first thought, even though my second was "no way is that the lunate, wtf would it be doing there?" But yeah, count the carpal bones and one of 'em has gone walkabout. Quote Link to comment Share on other sites More sharing options...
Aperry2182 Posted July 12, 2009 Share Posted July 12, 2009 I feel pretty good about this....Only first month of school down and I got the xray almost immediately although what has been said of it is correct. That is one wayyyyyyy displaced lunate. Now the EKG is another story. That will be for next semester. :D Thanks for the quizzes-they make us think! Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 11, 2009 Author Moderator Share Posted August 11, 2009 anything odd about this portable cxr ? (The spray paint look at the top is my first ever use of a photo editing system....) heartonright.bmp 1 Quote Link to comment Share on other sites More sharing options...
csmmedic Posted August 12, 2009 Share Posted August 12, 2009 Dextrocardia? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 12, 2009 Author Moderator Share Posted August 12, 2009 Dextrocardia? YUP, WHAT ELSE? Quote Link to comment Share on other sites More sharing options...
kimq26 Posted August 12, 2009 Share Posted August 12, 2009 YUP, WHAT ELSE? Situs inversus Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 12, 2009 Author Moderator Share Posted August 12, 2009 Situs inversus ding, ding, ding! Quote Link to comment Share on other sites More sharing options...
mschwanke Posted August 13, 2009 Share Posted August 13, 2009 Dang. I knew I should have checked out the new pic last night. It could have been my first correct answer since starting school. Talked about this a little during heart embryo. Pretty interesting stuff... Quote Link to comment Share on other sites More sharing options...
LobotomyPlzThx Posted December 30, 2009 Share Posted December 30, 2009 ding, ding, ding! I was gonna say "Wise guy Xray tech who wanted to pull a fast one by xraying the patient backwards..." Quote Link to comment Share on other sites More sharing options...
tjward10 Posted March 27, 2010 Share Posted March 27, 2010 How old was the female with brugada syndrome? Its a very interesting condition and one that EVERY person who looks at EKGs should recognize. It will certainly be life saving. Tim Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 27, 2010 Author Moderator Share Posted March 27, 2010 40 ish..... Quote Link to comment Share on other sites More sharing options...
tjward10 Posted March 27, 2010 Share Posted March 27, 2010 That is certainly very atipical. Generally people do not make it out of the second decade of life without an AICD. Something to keep in mind is that this condition has a very strong family tie! This condition is what causes a large portion of sudden cardiac arrest in young athletes. Tim Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 27, 2010 Author Moderator Share Posted March 27, 2010 re: young athletes- hypertrophic cardiomyopathy is also a common cause of sudden arrest. on P.E. look for a murmur that gets louder with squating, then order echo before clearing for sports. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 4, 2012 Author Moderator Share Posted April 4, 2012 bummer of a treadmill....let's call this one + (45 yr old female with atypical cp x 1 hr s/p 2 nl ekg's and 2 nl trops 6 hrs apart). cath showed multivessel dz.... Quote Link to comment Share on other sites More sharing options...
Just Steve Posted April 4, 2012 Share Posted April 4, 2012 auto converted or was there some chemical assistance? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 4, 2012 Author Moderator Share Posted April 4, 2012 auto converted or was there some chemical assistance? she was on the treadmill, stage 1 of a bruce protocol, said " I feel dizzy" concurrent with her 18 sec run of vtach. I stopped the test(duh) sat her down, put her on o2, reached for the amio and she converted back to nsr. I called cards and she was in the cath lab 30 min later and ended up with 2 stents if memory serves(this was a few yrs ago, I just found the ekg in my desk). 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 4, 2012 Author Moderator Share Posted April 4, 2012 A little more recent Quote Link to comment Share on other sites More sharing options...
Just Steve Posted April 4, 2012 Share Posted April 4, 2012 same patient? Second degree type I? I want to point a finger at injury in the anterior/inferior aspect due to the flipped T's but my ECG memory starts to get fuzzy in that department. I notice an absence of pathological q wave in aVF. Is the pronounced Q not a specific sign of an old MI? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 4, 2012 Author Moderator Share Posted April 4, 2012 different patient...and yes wenkebach( 2nd degree type 1) due to beta blocker o.d. there is a single isolated Q in III and widespread T wave inversion but this patient did not have chest pain, hx of MI or + enzymes. when she was in nsr again all of this resolved so was probably rate related. her chief complaint(for which she sat in the waiting room for 45 min unmonitored...) was "weakness" despite a reasonable bp. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 4, 2012 Author Moderator Share Posted April 4, 2012 extra credit. this is an atypical ekg presentation for this condition. 25 yr old male. weak and dizzy. prior hx of same without previous workup Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.