Cases and Examples

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Below you can find some common examples. ECGs can be magnified by clicking on the image....

Contents

Ischemia & Myocardial Infarction

An overview of the coronary arteries. LM = 'Left Main' = mainstem; LAD = 'Left Anterior Descending' artery; RCX = Ramus Circumflexus; RCA = 'Right Coronary Artery'.

Guess the culprit coronary artery that was occluded in these examples of myocardial infarctions

Examples of Myocardial Infarctions

Ami0001.jpg
MI 1
Where is this myocardial infarction located?
Case provided by
Ami0002.jpg
MI 2
Where is this myocardial infarction located?
Case provided by
Ami0003.jpg
MI 3
Where is this myocardial infarction located?
Case provided by
Ami0004.jpg
MI 4
Where is this myocardial infarction located?
Case provided by
Ami0005.jpg
MI 5
Where is this myocardial infarction located?
Case provided by
Ami0006.jpg
MI 6
Where is this myocardial infarction located?
Case provided by
Ami0007.jpg
MI 7
Where is this myocardial infarction located?
Case provided by
Ami0008.jpg
MI 8
Where is this myocardial infarction located?
Case provided by
Ami0009.jpg
MI 9
Where is this myocardial infarction located?
Case provided by
Ami0010.jpg
MI 10
Where is this myocardial infarction located?
Case provided by
Ami0011.jpg
MI 11
Where is this myocardial infarction located?
Case provided by
Ami0012.jpg
MI 12
Where is this myocardial infarction located?
Case provided by
Ami0013.jpg
MI 13
Where is this myocardial infarction located?
Case provided by
Casus2 2.jpg
MI 14
Where is this myocardial infarction located?
Case provided by
AMI anterior LAD.jpg
MI 15
Where is this myocardial infarction located?
Case provided by
KJcasus5.jpg
MI 16
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus6.jpg
MI 17
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus7.jpg
MI 18
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus8.jpg
MI 19
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus10.jpg
MI 20
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus12.jpg
MI 21
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus13.jpg
MI 22
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD
KJcasus16.jpg
MI 23
Where is this myocardial infarction located?
Case provided by C.J. Royaards, MD

Arrhythmias Cases

Casus1 2.jpg
Case 1
A 45 year old female presents at the first heart aid with chest complaints...
Case provided by Kees-Jan Royaards, MD
KJcasus3.jpg
Case 2
Wide complex tachycardia: ventricular or supraventricular? ...
Case provided by Kees-Jan Royaards, MD
KJcasus9.jpg
Case 3
Myocardial infarction or not? ...
Case provided by Kees-Jan Royaards, MD
Triblock.png
Case 4
Conduction trouble ...
Case provided by Kees-Jan Royaards, MD
JJ00004.png
Case 5
Sinus rhythm or not? ...
Case provided by JSSG de Jong, MD
ECG000006.jpg
Example 26
A patient presented with a broad complex tachycardia...
Case provided by

Electrolyte Disorders

KJcasu17-1.jpg
Case 100
Try to interprete this ECG using the 7+2 step method Look at the consecutive ECGs in this patient.
Case provided by C.J. Royaards, MD
KJcasu18-3.jpg
Case 101
Look at the consecutive ECGs in this patient. What electrolyte disturbance do you expect?
Case provided by C.J. Royaards, MD

Miscellaneous

Click on the text below the ECG for the answers. Click on the ECG for enlargement of the ECG itself...

RVDB1.jpg
Example 23

Case provided by
DVA0011.jpg
Example 24
Typical Brugada syndrome ST segments in right precordial ECG leads (on spot diagnosis) aka 'type-1 Brugada ECG' with 1st degree AV block and broad P-waves.
Case provided by W.G. de Voogt, MD, PhD
DVA0229.jpg
Example 25
A regular small-QRS tachycardia at about 300bpm with normal looking QRS complexes is most likely an Atrial flutter with 1:1 conduction over the AV node.
Case provided by W.G. de Voogt, MD, PhD

Rhythm Puzzles by Prof. A.A.M. Wilde

Puzzle2009 08.jpg
An Unexpected Narrow QRS Complex
A 95-year-old woman presents with palpitations. She has no relevant medical history and the present complaint is several days old...
Case provided by A.A.M. Wilde
Puzzle2009 04.jpg
An Irregular Heart Beat
A 71-year-old female patient presents to your outpatients clinic with an irregular heart rhythm. The complaints started a few weeks ago and seem to worsen...
Case provided by A.A.M. Wilde
Puzzle2009 02.jpg
Syncope in an Old Lady
An 83-old-female patient presents to your outpatient clinic with a history of syncope. It has occurred three times in the last few months and there were no specific triggers...
Case provided by A.A.M. Wilde
Puzzle 2008 04 014 fig1a.png
Wide QRS Complexes in the Setting of Acute Myocardial Infarction: Good News or Bad?
A 57-year-old man collapsed after one hour of angina symptoms in the presence of the alarmed ambulance personnel. He had never had any complaints...
Case provided by N.J.W. Verouden, R.J. de Winter, A.A.M. Wilde
Puzzle 2008 01 062 fig1.jpg
Just an Ordinary Flutter?
A 44-year-old male presented with palpitations. His medical history was otherwise uneventful and the family history revealed pacemaker...
Case provided by A.A.M. Wilde, J. Hrudova, J.G.M. Tans
Puzzle 2008 03 01.jpg
Wide Complexes Intervening Regular Sinus Rhythm - 3
A 73-year-old man presents with palpitations (irregular heartbeat). There is no medical history. Physical examination reveals no abnormalities...
Case provided by A.A.M. Wilde
Puzzle 2008 05 01.jpg
Wide Complexes Intervening Regular Sinus Rhythm - 4
A 55-year-old male without cardiac history is complaining of an irregular heartbeat. Physical examination and an echo reveal no abnormalities...
Case provided by A.A.M. Wilde
Puzzle 2008 06 01.jpg
The ECG of a Cardiomyopathy - 2
A 36-year-old male comes to your outpatient clinic because of his family history. His father died suddenly at age 43 and his brother died suddenly at age 39...
Case provided by A.A.M. Wilde
Puzzle 2007 1 33 fig1.jpg
Wide Complexes Intervening Regular Sinus Rhythm - 2
A 38-year-old male patient presents with palpitations. He is not suffering from syncope or dizziness and has no other complaints...
Case provided by A.A.M. Wilde
Puzzle 20075 2 072 fig1.jpg
Palpitations after a MAZE Procedure
A 75-year-old lady presented with palpitations. Her medical history reveals cardiac surgery with a mitral valve repair combined...
Case provided by A.A.M. Wilde, H.H.D. Idzerda
Puzzle 2007 03 114 fig1.jpg
Abnormal Repolarization, Spot Diagnosis?
A boy with a birth weight of 3.030 g was born by caesarean section at 33 weeks of gestation because of bradycardia and severe...
Case provided by A.A.M. Wilde, N.A. Blom
Puzzle 2005 4 157 fig1.jpg
An Irregular Rhythm at Older Age
An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history...
Case provided by A.A.M. Wilde
Puzzle 2007 5 198 fig1.jpg
Palpitations all the Time
A 14-year-old girl complained of palpitations that occurred numerous times a week. There were no special triggers and, usually...
Case provided by A.A.M. Wilde, M. Cuppen, J.L.R.M. Smeets
Puzzle 2007 6 231 fig1.jpg
Five Years of Palpitations
A 43-year-old man came to the outpatient clinic for preventive cardiovascular (CV) screening. During the last five years he...
Case provided by N.M. Panhuyzen-Goedkoop, L.R.C. Dekker, A.A.M. Wilde
Puzzle 2007 12 426 fig1.jpg
An Abnormal ECG?
A 47-year-old lady presents with an ‘abnormal ECG’. In her family three daughters suffer from a long-QT syndrome type 2...
Case provided by A.A.M. Wilde
Puzzle 2005 12 466 fig1.jpg
Right You Are
A 63-year-old female was referred to our outpatient clinic with symptoms of palpitations. These had been occurring in paroxysms...
Case provided by T.A. Simmers, A.A.M. Wilde
Puzzle 2006 1 33 fig1.jpg
Should I be Worried?
A 34-year old man comes to your office. He has read in a newspaper about the familial occurrence of sudden death. He suffered a...
Case provided by A.A.M. Wilde, H.L. Tan
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A Pre-excited Wide QRS Complex: is That all There is?
A 28-year-old male was referred because of an abnormal ECG. He was having occasional palpitations. His family history is unremarkable...
Case provided by A.A.M. Wilde, L.R.C. Dekker
Puzzle 2006 4 154 fig1.jpg
An Old Lady with Chest Pain
A 90-year-old lady presented with chest pain which had a sudden onset in the middle of the night. There were no other symptoms...
Case provided by A.A.M. Wilde
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Palpitations and Dizziness in a 65-Year-Old-Man
A 65-year-old male presented with palpitations and dizziness of sudden onset, without any associated chest pain or other symptoms...
Case provided by A.A.M. Wilde
Puzzle 2006 08 268 fig1.jpg
A Narrow QRS Complex Tachycardia Sensitive to Isoptin
A 54-year-old man presented with palpitations. He had no other symptoms. Physical examination revealed, with the exception of a...
Case provided by A.A.M. Wilde, R.H. Bakker
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And What About the ECG?
A 63-year-old lady presented with episodic chest pain without specific triggers (in particular no relation with exercise)...
Case provided by A.A.M. Wilde, R.H.J. Peters
Puzzle 2006 11 393 fig1.jpg
Palpitations Again, Have a Closer Look
An otherwise healthy 57-year-old lady presented with palpitations without dizziness. The symptoms had been present for a couple...
Case provided by A.A.M. Wilde, L.R.C. Dekker
Puzzle 2006 12 436 fig1.jpg
Wide Complexes Intervening Regular Sinus Rhythm
A 28-year-old, wheelchair bound, female patient with Friedreich’s ataxia presents with an irregular heartbeat...
Case provided by A.A.M. Wilde
Puzzle 2005 1 23 fig1.jpg
ECG puzzle: Appearances Can be Deceiving
A 61-year-old male was referred with symtoms of exertional dyspnoea and palpitations. He had suffered an anterior myocardial...
Case provided by T.A. Simmers
Puzzle 2005 2 67 fig1.jpg
Where Do the Extras Come From?
A 64-year-old man had an inferior myocardial infarction ten years ago. Lately he has been having palpitations with occasional dizziness...
Case provided by A.A.M. Wilde, R.B.A. van den Brink
Puzzle 2005 4 156 fig1.jpg
The Turtle and the Hare
An otherwise healthy 32-year-old male was referred with palpitations. Attacks had been occurring monthly for several years...
Case provided by A.A.M. Wilde, R.B.A. van den Brink
Puzzle 2005 5 195 fig1.jpg
Now You See it, Now You Don't
An otherwise healthy 66-year-old male was referred with complaints of central chest pain. He was not on any medication...
Case provided by T.A. Simmers, A.A.M. Wilde
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It's Not What You Think it Is
A 20-year-old male is having palpitations. They occur without a specific trigger, although episodes are sometimes related to...
Case provided by A.A.M. Wilde, R.B.A. van den Brink
Puzzle 2005 8 285 fig1.jpg
One is Enough, Two is Too Many
An otherwise healthy 24-year-old man was referred to our hospital because of drug refractory spells of palpitations accompanied by dizziness...
Case provided by A.A.M. Wilde, R.B.A. van den Brink
Puzzle 2005 10 373 fig1.jpg
The ECG of a (Cardio)myopathy?
A 33-year-old lady visited the cardiologist because of the sudden death of her brother at age 35. He died while watching TV...
Case provided by A.A.M. Wilde, Y.M. Pinto
Puzzle 2005 11 428 fig1.jpg
The Ions Have It
A 46-year-old male was admitted to our emergency room with dyspnoea. His medical history included congestive heart failure with a left ventricular ejection
Case provided by T.A. Simmers, A.A.M. Wilde
Puzzle 2004 2 73.jpg
A fainting lady with some extrasystoles
A 30-year-old woman presents with repeated syncope. Her symptoms started a few months ago without a particular trigger...
Case provided by A.A.M. Wilde and H. Tan
Puzzle 2004 4 178 fig1.jpg
Syncopated Rhythm
A 65-year-old woman was admitted because of recurrent syncope. Her complaints were difficult to interpret due to mental...
Case provided by L.R.C. Dekker, R. Tukkie
Puzzle 2007 4 157 fig1.jpg
An Irregular Rhythm at Older Age
An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history...
Case provided by A.A.M. Wilde
Puzzle 2004 6 302 fig1.jpg
I Think a Niece of Mine was Referred to a Neurologist
In the setting of family screening, an 84-year-old lady was invited for a cardiogenetic evaluation. Two of her grandchildren...
Case provided by A.A.M. Wilde, T.A. Simmers
Nhj 2004 8 355.jpg
Just One Collapse During Soccer
A 14-year-old boy died suddenly while playing soccer. He was in the middle of a sprint when he suddenly succumbed...
Case provided by A.A.M. Wilde, T.A. Simmers
Puzzle 2004 10 469 fig1.png
Tachycardia Terminated by Adenosine
A 27-year-old female was referred to the emergency room with rapid palpitations...
Case provided by I.C.D. Westendorp, G.S. de Ruiter, L.V.A. Boersma, E.F.D. Wever
Nhj 2004 11 510-1.jpg
Nightly Phenomena, Day Time Work?
In 2002, an a trial demand inhibited (AAI) pacemaker was implanted in a young male (born 1984) because of a primary arrhythmia disorder.
Case provided by R. Tukkie, R. Rienks, A.A.M. Wilde

Case reports by W.G. De Voogt, MD, PhD

DVA0003.jpg
Case: what kind of block?
This Holter registration shows pauses.
Case provided by W.G. De Voogt, MD, PhD
DVA0004.jpg
Case: a slow heart rate
This ECG shows pauses in the heart rhythm.
Case provided by W.G. De Voogt, MD, PhD
DVA0005.jpg
Case: a pause in the heart rate
This tracing shows a pause in the heart rhythm.
Case provided by W.G. De Voogt, MD, PhD
DVA0006.jpg
Case: fever with arrhythmias
This is a tracing of a 52 year old male, with viral infection and high fever (40° C), who was admitted to the...
Case provided by W.G. De Voogt, MD, PhD

Case reports from the ICBA

ICBA00001.jpg
Fusion beats
Sinus bradycardia, Second degree 2:1 AV block with LBBB in the conducted beats and junctional escape beats with RBBB morphology and fusion beats that mimic normal intraventricular conduction.
Case provided by Dr. Alberto Giniger
ICBA00002.jpg
LBBB and RBBB
Sinus rythm, 2:1 AV block with RBBB in the left part of the EKG and after a 1:1 conducted beat with LBBB the 2:1 AV block continues with LBBB. So it is a bilateral branch block.
Case provided by Dr. Alberto Giniger
ICBA00003.jpg
Fusion beats
Sinus rythm, high degree AV block, conducted beats with RBBB and ventricular escape beats with LBBB image. Some fusion beats mimic no intraventricular disturbance confundinc as normal conducted beats.
Case provided by Dr. Alberto Giniger
ICBA00004.jpg
Escape beats
Sinus rythm, high degree AV block with unional escape beats and capture beats with RBBB.
Case provided by Dr. Alberto Giniger
ICBA00008.jpg
Orthodromic tachycardia in WPW
AV orthodromic tachycardia (WPW syndrome).
Case provided by Dr. Alberto Giniger
ICBA00010.jpg
Ventricular tachcyardia
Ventricular tachycardia or idioventricular rythm during sinus tachycardia with fusion beats.
Case provided by Dr. Alberto Giniger
ICBA00005.jpg
Escape rhythm with RBBB pattern

Case provided by Dr. Alberto Giniger
ICBA00006.jpg
Escape rhythm with LBBB pattern
Escape rhythm with left bundle branch block pattern and likely retrograde conducted P waves.
Case provided by Dr. Alberto Giniger
ICBA00007.jpg
Intermittent pre-exitation
Intermittent pre-exitation
Case provided by Dr. Alberto Giniger
ICBA00009.jpg
Sinus irregularity
SA exit block
Case provided by Dr. Alberto Giniger
ICBA00011.jpg
Complete AV block and left ventricle escape
Complete AV block and left ventricle escape.
Case provided by Dr. Alberto Giniger
ICBA00012.jpg
Idionodal escape rythm and ventricular capture by AV nodal reentry
Idionodal escape rythm and ventricular capture by AV nodal reentry...
Case provided by Dr. Alberto Giniger
ICBA00013.jpg
Idioventricular rythm with 1:1 V-A conduction
Idioventricular rythm with 1:1 V-A conduction.
Case provided by Dr. Alberto Giniger
ICBA00014.jpg
Mobitz II AV block with LBBB in the conducted beats
Mobitz II AV block with LBBB in the conducted beats.
Case provided by Dr. Alberto Giniger
ICBA00015.jpg
Idioventricular accelerated rythm with fusion beats
Idioventricular accelerated rythm with fusion beats.
Case provided by Dr. Alberto Giniger
ICBA00016.jpg
AV nodal reentry tachycardia
AV nodal reentry tachycardia. Also look at the below ladder diagram.
Case provided by Dr. Alberto Giniger
ICBA00017.jpg
3:1 AV block with idionodal escape (the third P wave is inside the QRS)
AV block with idionodal escape (the third P wave is inside the QRS).
Case provided by Dr. Alberto Giniger
ICBA00018.jpg
Sinus bradicardia and isorythmic nodal escapes
Sinus bradicardia and isorythmic nodal escapes.
Case provided by Dr. Alberto Giniger
ICBA00019.jpg
Coarse atrial fibrillation mimic atrial flutter
Coarse atrial fibrillation mimic atrial flutter.
Case provided by Dr. Alberto Giniger
ICBA00020.jpg
Long QT and VPB secondary to sotalol administration
Long QT and VPB secondary to sotalol administration
Case provided by Dr. Alberto Giniger
ICBA00023.jpg
Intermittent WPW
Intermittent WPW
Case provided by Dr. Alberto Giniger