ECG

Wellens’ Syndrome

Brittany Perry Hoffstatter, DO^* and Brian Walsh, MD^*

DOI: https://doi.org/10.21980/J8FS8KIssue 4:1 No ratings yet.

Initial electrocardiogram (ECG) revealed the classic biphasic T waves in V2 and V3 of Wellen’s syndrome (see red outlines). A second EKG demonstrated an evolving deeply inverted T wave (see blue outlines).

Visual EM Cardiology/Vascular

Guilty as Charged: Jailed Coronary Vessel Presenting as Wellens’ Syndrome Type B

Aderonke Susan Akapo, DO^*, Ryan Fashempour^*, Mohamad Moussa, MD^* and Patrick Bruss, MD^{^}

DOI: https://doi.org/10.21980/J8DS6H Issue 4:1 No ratings yet.

Evolving changes to electrocardiograph (ECG) were noted during serial ECG monitoring involving leads V2 and V3, along with some T-wave inversion in V4 and V5 that were concerning for a Wellens’ syndrome type B on second ECG. She was admitted and subsequently taken to cardiac catheterization suite where it was revealed that the previously placed stent in the left anterior descending (LAD) artery was patent. Unfortunately, the stent blocked off an adjacent side branch vessel off the LAD in proximal two-third region of the stent (as seen in the cartoon).

Visual EM Cardiology/Vascular

Clinical Evaluation and Management of Pediatric Pericarditis

Sharona Hariri, BA^*, Alisa Wray, MD, MAEd^{^} and Lauren Sylwanowicz, MD^{^}

DOI: https://doi.org/10.21980/J8HP85Issue 3:4 No ratings yet.

An electrocardiogram (ECG) was concerning for ST segment elevation in leads II, III, aVF, and V4, with subtle ST elevations in V5 and V6 (see black arrows). There is also ST segment depression in aVL (see blue arrows).

Cardiology/Vascular Visual EM

Don’t Forget the Pacemaker – A Rare Complication

Amanda Esposito, MD^*, Kenneth Rapp, MD^* and Albert Ritter, MD^*

DOI: https://doi.org/10.21980/J8GS7HIssue 3:4 No ratings yet.

The ECG demonstrated the presence of pacemaker spikes without appropriate capture (green arrows) and a ventricular escape rhythm which can be identified by an absence of P waves prior to the QRS complex (purple arrows). The portable chest X- demonstrated displaced pacemaker leads (red arrows) that were coiled around the pulse generator (blue arrow).

Cardiology/Vascular Visual EM

Propafenone Overdose-induced Arrhythmia and Subsequent Correction After Administration of Sodium Bicarbonate

Patrick Bruss, MD^* and Peter Fuller, MD^{^}

DOI: https://doi.org/10.21980/J8D925Issue 3:2 No ratings yet.

The first ECG in this case showed sinus tachycardia with a widened QRS (black arrow), a rightward axis, prolonged corrected QT interval (QTc), and terminal R wave in AVR (white arrow). There are several potential causes for these ECG findings, but put together with the patient’s history, we were suspicious of sodium channel blockers being the most likely cause. The second ECG, after sodium bicarbonate was administered, demonstrated a normal QRS (black arrow) and no rightward axis deviation, reduction of the QTC and resolution of the terminal R wave (white arrow). We later learned that the patient’s cardiologist recently increased her propafenone dose.

Toxicology Visual EM

Osborn Waves in a Severely Hypothermic Patient

Jon Van Heukelom, MD^*

DOI: https://doi.org/10.21980/J8H34SIssue 3:2 No ratings yet.

The initial EKG shows marked elevation of the J-point (point where the QRS segment joins the ST segment), otherwise known as an “Osborn Wave” (see black arrows). A subsequent EKG obtained after active rewarming, showed resolution of the Osborn waves.

Cardiology/Vascular Visual EM

Torsades de Pointes

Richard J Chen, MD^*, Grant Wei, MD^* and Chirag Shah, MD^*

DOI: https://doi.org/10.21980/J87K91 Issue 3:2 No ratings yet.

The patient was found to be in a polymorphic ventricular tachycardia; he was alert, awake and asymptomatic. A rhythm strip showed a wide complex tachycardia with the QRS complex varying in amplitude around the isoelectric line consistent with Torsades de Pointes.

Cardiology/Vascular Visual EM

Type 1 Brugada Syndrome

Sha Yan, DO^*, Grant Wei, MD^* and Chirag Shah, MD^*

DOI: https://doi.org/10.21980/J8V91T Issue 3:2 No ratings yet.

ECG shows an incomplete right bundle branch block (blue arrow) with coved ST segment elevation and an inverted T wave in V1 (red arrow) and ST segment elevation in V2 (black arrow).

Cardiology/Vascular Visual EM

Osborn Waves

James Elliot Karz, DO^*, Grant Wei, MD^* and Chirag Shah, MD^*

DOI: https://doi.org/10.21980/J8G34G Issue 3:2 No ratings yet.

The initial ECG shows a junctional rhythm with Osborn waves (or J point elevations/J waves) in the lateral precordial leads, as well as the limb leads (Image 1). The second ECG, 49 minutes later, shows an improving ventricular rate and Osborn wave height decrease of approximately 50% (Image 2).

Cardiology/Vascular Visual EM

Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG

Samer Assaf, MD^* and Christopher Libby, MD, MPH^{^}

DOI: https://doi.org/10.21980/J8T05X Issue 2:3 No ratings yet.

The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms.

Cardiology/Vascular Visual EM