Case reports from Michael Rosengarten

This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia. Previous Case: / | Next Case: McGill Case 1

Conduction Abnormalities

Intraventricular conduction defect

• A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.
• A 62 year old man with a severe intra-ventricular conduction defect simulating ventricular bigemini.

Right Bundle Branch Block

• An elderly man with RBBB and possible LPHB.
• An elderly man with RBBB and atrial flutter.
• A patient with PACs conducted with a RBBB.
• A patient with a RBBB and PACs.
• A patient with a RBBB secondary to massive Pulmonary embolism.
• A 35 yr. old patient with possible Chagas disease induced right bundle branch block.

Left Bundle Branch Block

• Recordings of rate dependent left bundle branch block.
• Case two.
• Left bundle branch block and first degree A/V block.

Left Anterior Fasicular Block

• Case one (in the setting of an acute anterior wall MI)
• in a middle aged man with first degree block.
• an 80 year old man.
• A 77 year old man with previous myocardial infarction.

Left Posterior Fasicular Block

• A 19 year old boy with an normal echocardiogram.

Bifasicular block

Right bundle branch block with left anterior hemi-block

• In a 41 year old patient who had had surgical correction of Tetalogy of Fallot.
• With possible RVH.
• In a patient with atrial fibrillation.
• In a elderly man with possible left atrial abnormality.
• 54 year old man with a heart transplant.

Right bundle branch block with left posterior hemi-block

• A patient on the hospital ward with RBBB, Left Posterior Hemiblock, criteria for LAA and RAA.
• An elderly woman with a history of ventricular tachycardia

Alternating Bundle Branch Block

• Case one

Trifasicular block

• Case one
• Case two
• Case three

First degree block:

• A 77 year old man with previous myocardial infarction.
• A 63 year old man
• second case
• third case
• In a middle aged man with LAFB
• In a 20 year old woman with Ebstien's anomaly
• In an 87 year old man with a VVI pacemaker

Second degree block

Mobitz I

• Mobitz I A/V block and high grade A/V block from a woman with pre-syncope.

Mobitz II

• A patient with MobitzII A/V block post pacemaker implant for syncope
• From a Holter recording from a middle aged woman, also shows 2:1 block

Complete heart block

• Complete heart block detected with a Reveal implantable monitor.
• A 65 year old woman with tiredness and difficulty walking. The EKG shows complete heart block.
• An 85 year old patient with previous trifasicular block

Sinus Node Block:

• A middle aged woman treated for atrial fibrillation with a possible sinus node exit block (Mobitz 1)

Arrhythmias

Supraventricular Arrhythmias

Sinus pauses

• From a Holter monitor
• On termination of atrial fibrillation

Premature atrial complexes

• Case one
• Case two
• PACs in trigemini

Atrial fibrillation

• Atrial fibrillation in a patient with a RBBB and LAHB
• Atrial fibrillation in an elderly man
• A 64 year old woman with atrial fibrillation and left ventricular hypertrophy
• A 84 year old woman
• Case three with a first EKG showing left atrial abnormality and a second with atrial fibrillation

Supraventricular Tachycardia

Without block

• A 70 year old man with supraventricular tachycardia for years

With block

• Supraventricular tachycardia with block in a woman in her fifties.
• A 72 year old man with supraventricular tachycardia with block or slow atrial flutter.
• Supraventricular tachycardia/flutter with increased ventricular response after IV diltiazem.
• A tracing from an 80 year old man post aortic valve replacement.
• A 12 lead EKG from a 72 year old man with supraventricular tachycardia with 2:1 block.
• An elederly woman with a mitral valve replacement.

Atrial Flutter

• Atrial flutter with 4:1 block and RBBB.
• Supraventricular tachycardia/flutter with increased ventricular response after IV diltiazem.
• A wide complex tachycardia (atrial flutter with 1:1 conduction) in a patient with corrected Tetralogy of Fallot. Recorded with a loop monitor.
• A case of tachy-brady syndrome. The recording is from a loop recorder and shows atrial flutter followed by asystole.
• A patient in the hospital with atrial flutter and a slow ventricular response.
• A 65 year old man'
• A man in his 50's before and after adenosine.

Nodal Rhythm:

• Three ECGs (0ne of which is nodal rhythm ) and X-ray from a patient with syncope and chest pain.
• Accelerated nodal rhythm
• Nodal rhythm in a woman in her fifties.
• Accellerated nodal rhythm in a woman in her seventies.

Wolf Parkinson White

• WPW in a 55 year old woman
• WPW in a 43 year old man
• Case three
• Case four
• Case five
• Case six

Other atrial rhythms

• 54 year old man with a heart transplant.

Ventricular Arrhythmias

Premature Complexes

• In an 87 year old man.

Bigemini

• PVCs in bigemini in a 75 year old woman.
• PVCs in bigemini in a 75 year old woman #2
• Bigemini in a 60 year old man
• Interpolated PVCs in a 80 year old woman.
• A patient on the hospital ward with PVCs as well as RBBB, Left Posterior Hemiblock, criteria for LAA and RAA.
• PVC couplets.
• PVC salvos

Ventricular Tachycardia

• Two EKG strips from a patient with a failing pacemaker and Torsade de Pointes ventricular tachycardia
• An EKG from a patient in the surgical recovery room showing Torsade de Pointes ventricular tachycardia
• From an elderly woman
• Ventricular tachycardia an elderly woman
• Two ECGs from a patient in an emergency room, first with ventricular tachycardia and then after a shock, sinus rhythm.
• A 66 year old man with fast ventricular tachycardia
• A 35 year old man with an acute inferior wall M.I. and ventricular tachycardia.
• 12 lead recording of ventricular tachycardia with intracardiac recordings in a patient with a dual chamber pacer/defibrillator and a severe intra-ventricular conduction defect.
• VT in 62 year old man with a previous inferior wall myocardial infarction and a history of ventricular tachycardia. This page shows his EKG and an abnormal surface average EKG.

Ventricular Fibrillation

• 12 lead recordings from two patients with ventricular fibrillation
• Ventricular capture beats with paced ventricular rhythm
• A patient with recurrent wide complex tachycardia
• A 70 year old woman with recurrent ventricular tachycardia and a severe intra-ventricular conduction defect.