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[[Image:coronary_anatomy.png|thumb| An overview of the coronary arteries. LM = 'Left Main' = mainstem; LAD = 'Left Anterior Descending' artery; RCX = Ramus Circumflexus; RCA = 'Right Coronary Artery'.]] | [[Image:coronary_anatomy.png|thumb| 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 | Guess the culprit coronary artery that was occluded in these examples of myocardial infarctions | ||
{| | |||
'''Examples of Myocardial Infarctions''' | |||
| | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
| | |- valign="top" | ||
{{Smallcase| | |||
|File=Ami0001.jpg | |||
|Link=MI 1 | |||
|Description='''MI 1'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0002.jpg | |||
|Link=MI 2 | |||
|Description='''MI 2'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
| | }} | ||
{{Smallcase| | |||
|File=Ami0003.jpg | |||
|Link=MI 3 | |||
|Description='''MI 3'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=Ami0004.jpg | |||
|Link=MI 4 | |||
|Description='''MI 4'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0005.jpg | |||
|Link=MI 5 | |||
|Description='''MI 5'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0006.jpg | |||
|Link=MI 6 | |||
|Description='''MI 6'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=Ami0007.jpg | |||
|Link=MI 7 | |||
|Description='''MI 7'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0008.jpg | |||
|Link=MI 8 | |||
|Description='''MI 8'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0009.jpg | |||
|Link=MI 9 | |||
|Description='''MI 9'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=Ami0010.jpg | |||
|Link=MI 10 | |||
|Description='''MI 10'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0011.jpg | |||
|Link=MI 11 | |||
|Description='''MI 11'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Ami0012.jpg | |||
|Link=MI 12 | |||
|Description='''MI 12'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=Ami0013.jpg | |||
|Link=MI 13 | |||
|Description='''MI 13'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=Casus2_2.jpg | |||
|Link=MI 14 | |||
|Description='''MI 14'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=AMI_anterior_LAD.jpg | |||
|Link=MI 15 | |||
|Description='''MI 15'''<br/>Where is this myocardial infarction located? | |||
|Contributor= | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=KJcasus5.jpg | |||
|Link=MI 16 | |||
|Description='''MI 16'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
{{Smallcase| | |||
|File=KJcasus6.jpg | |||
|Link=MI 17 | |||
|Description='''MI 17'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
{{Smallcase| | |||
|File=KJcasus7.jpg | |||
|Link=MI 18 | |||
|Description='''MI 18'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=KJcasus8.jpg | |||
|Link=MI 19 | |||
|Description='''MI 19'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
{{Smallcase| | |||
|File=KJcasus10.jpg | |||
|Link=MI 20 | |||
|Description='''MI 20'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
{{Smallcase| | |||
|File=KJcasus12.jpg | |||
|Link=MI 21 | |||
|Description='''MI 21'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=KJcasus13.jpg | |||
|Link=MI 22 | |||
|Description='''MI 22'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
{{Smallcase| | |||
|File=KJcasus16.jpg | |||
|Link=MI 23 | |||
|Description='''MI 23'''<br/>Where is this myocardial infarction located? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
|} | |} | ||
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|File=Casus1_2.jpg | |File=Casus1_2.jpg | ||
|Link=Case 1 | |Link=Case 1 | ||
|Description=A 45 year old female presents at the first heart aid with chest complaints... | |Description='''Case 1'''<br/>A 45 year old female presents at the first heart aid with chest complaints... | ||
|Contributor=Kees-Jan Royaards, MD | |Contributor=Kees-Jan Royaards, MD | ||
}} | }} | ||
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|File=KJcasus3.jpg | |File=KJcasus3.jpg | ||
|Link=Case 2 | |Link=Case 2 | ||
|Description=Wide complex tachycardia: ventricular or supraventricular? ... | |Description='''Case 2'''<br/>Wide complex tachycardia: ventricular or supraventricular? ... | ||
|Contributor=Kees-Jan Royaards, MD | |Contributor=Kees-Jan Royaards, MD | ||
}} | }} | ||
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|File=KJcasus9.jpg | |File=KJcasus9.jpg | ||
|Link=Case 3 | |Link=Case 3 | ||
|Description=Myocardial infarction or not? ... | |Description='''Case 3'''<br/>Myocardial infarction or not? ... | ||
|Contributor=Kees-Jan Royaards, MD | |Contributor=Kees-Jan Royaards, MD | ||
}} | }} | ||
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|File=Triblock.png | |File=Triblock.png | ||
|Link=Case 4 | |Link=Case 4 | ||
|Description=Conduction trouble ... | |Description='''Case 4'''<br/>Conduction trouble ... | ||
|Contributor=Kees-Jan Royaards, MD | |Contributor=Kees-Jan Royaards, MD | ||
}} | }} | ||
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|File=JJ00004.png | |File=JJ00004.png | ||
|Link=Case 5 | |Link=Case 5 | ||
|Description=Sinus rhythm or not? ... | |Description='''Case 5'''<br/>Sinus rhythm or not? ... | ||
|Contributor=JSSG de Jong, MD | |Contributor=JSSG de Jong, MD | ||
}} | }} | ||
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|File=ECG000006.jpg | |File=ECG000006.jpg | ||
|Link=Example 26 | |Link=Example 26 | ||
|Description=A patient presented with a broad complex tachycardia... | |Description='''Example 26'''<br/>A patient presented with a broad complex tachycardia... | ||
|Contributor= | |Contributor= | ||
}} | }} | ||
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==Electrolyte Disorders== | ==Electrolyte Disorders== | ||
{| width="67%" cellspacing="10" style="font-size: 90%;padding: 3px; " | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=KJcasu17-1.jpg | |||
|Link=Case 100 | |||
|Description='''Case 100'''<br/>Try to interprete this ECG using the 7+2 step method Look at the consecutive ECGs in this patient. | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
{{Smallcase| | |||
|File=KJcasu18-3.jpg | |||
|Link=Case 101 | |||
|Description='''Case 101'''<br/>Look at the consecutive ECGs in this patient. What electrolyte disturbance do you expect? | |||
|Contributor=C.J. Royaards, MD | |||
}} | |||
|} | |||
==Miscellaneous== | ==Miscellaneous== | ||
Click on the text below the ECG for the '''answers'''. Click on the ECG for '''enlargement of the ECG''' itself... | Click on the text below the ECG for the '''answers'''. Click on the ECG for '''enlargement of the ECG''' itself... | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=RVDB1.jpg | |||
</ | |Link=Example 23 | ||
|Description='''Example 23'''<br/> | |||
|Contributor= | |||
}} | |||
{{Smallcase| | |||
|File=DVA0011.jpg | |||
|Link=Example 24 | |||
|Description='''Example 24'''<br/>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. | |||
|Contributor=W.G. de Voogt, MD, PhD | |||
}} | |||
{{Smallcase| | |||
|File=DVA0229.jpg | |||
|Link=Example 25 | |||
|Description='''Example 25'''<br/>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. | |||
|Contributor=W.G. de Voogt, MD, PhD | |||
}} | |||
|} | |||
==Rhythm Puzzles | ==Rhythm Puzzles by Prof. A.A.M. Wilde== | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
|- valign="top" | |- valign="top" | ||
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|File=Puzzle2009_08.jpg | |File=Puzzle2009_08.jpg | ||
|Link=An Unexpected Narrow QRS Complex -1- | |Link=An Unexpected Narrow QRS Complex -1- | ||
|Description=A 95-year-old woman presents with palpitations. She has no relevant medical history and the present complaint is several days old... | |Description='''An Unexpected Narrow QRS Complex'''<br/>A 95-year-old woman presents with palpitations. She has no relevant medical history and the present complaint is several days old... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle2009_04.jpg | |File=Puzzle2009_04.jpg | ||
|Link=An Irregular Heart Beat | |Link=An Irregular Heart Beat | ||
|Description=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... | |Description='''An Irregular Heart Beat'''<br/>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... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle2009_02.jpg | |File=Puzzle2009_02.jpg | ||
|Link=Syncope in an Old Lady | |Link=Syncope in an Old Lady | ||
|Description=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... | |Description='''Syncope in an Old Lady'''<br/>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... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
|} | |} | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
|- valign="top" | |- valign="top" | ||
Line 116: | Line 265: | ||
|File=Puzzle_2008_04_014_fig1a.png | |File=Puzzle_2008_04_014_fig1a.png | ||
|Link=Wide QRS Complexes in the Setting of Acute Myocardial Infarction: Good News or Bad? | |Link=Wide QRS Complexes in the Setting of Acute Myocardial Infarction: Good News or Bad? | ||
|Description=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... | |Description='''Wide QRS Complexes in the Setting of Acute Myocardial Infarction: Good News or Bad?'''<br/>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... | ||
|Contributor=N.J.W. Verouden, R.J. de Winter, A.A.M. Wilde | |Contributor=N.J.W. Verouden, R.J. de Winter, A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2008_01_062_fig1.jpg | |File=Puzzle_2008_01_062_fig1.jpg | ||
|Link=Just an Ordinary Flutter? | |Link=Just an Ordinary Flutter? | ||
|Description=A 44-year-old male presented with palpitations. His medical history was otherwise uneventful and the family history revealed pacemaker... | |Description='''Just an Ordinary Flutter?'''<br/>A 44-year-old male presented with palpitations. His medical history was otherwise uneventful and the family history revealed pacemaker... | ||
|Contributor=A.A.M. Wilde, J. Hrudova, J.G.M. Tans | |Contributor=A.A.M. Wilde, J. Hrudova, J.G.M. Tans | ||
}} | }} | ||
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|File=Puzzle_2008_03_01.jpg | |File=Puzzle_2008_03_01.jpg | ||
|Link=Wide Complexes Intervening Regular Sinus Rhythm - 3 | |Link=Wide Complexes Intervening Regular Sinus Rhythm - 3 | ||
|Description=A 73-year-old man presents with palpitations (irregular heartbeat). There is no medical history. Physical examination reveals no abnormalities... | |Description='''Wide Complexes Intervening Regular Sinus Rhythm - 3'''<br/>A 73-year-old man presents with palpitations (irregular heartbeat). There is no medical history. Physical examination reveals no abnormalities... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2008_05_01.jpg | |File=Puzzle_2008_05_01.jpg | ||
|Link=Wide Complexes Intervening Regular Sinus Rhythm - 4 | |Link=Wide Complexes Intervening Regular Sinus Rhythm - 4 | ||
|Description=A 55-year-old male without cardiac history is complaining of an irregular heartbeat. Physical examination and an echo reveal no abnormalities... | |Description='''Wide Complexes Intervening Regular Sinus Rhythm - 4'''<br/>A 55-year-old male without cardiac history is complaining of an irregular heartbeat. Physical examination and an echo reveal no abnormalities... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2008_06_01.jpg | |File=Puzzle_2008_06_01.jpg | ||
|Link=The ECG of a Cardiomyopathy - 2 | |Link=The ECG of a Cardiomyopathy - 2 | ||
|Description=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... | |Description='''The ECG of a Cardiomyopathy - 2'''<br/>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... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
|} | |} | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
|- valign="top" | |- valign="top" | ||
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|File=Puzzle_2007_1_33_fig1.jpg | |File=Puzzle_2007_1_33_fig1.jpg | ||
|Link=Wide Complexes Intervening Regular Sinus Rhythm - 2 | |Link=Wide Complexes Intervening Regular Sinus Rhythm - 2 | ||
|Description=A 38-year-old male patient presents with palpitations. He is not suffering from syncope or dizziness and has no other complaints... | |Description='''Wide Complexes Intervening Regular Sinus Rhythm - 2'''<br/>A 38-year-old male patient presents with palpitations. He is not suffering from syncope or dizziness and has no other complaints... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_20075_2_072_fig1.jpg | |File=Puzzle_20075_2_072_fig1.jpg | ||
|Link=Palpitations after a MAZE Procedure | |Link=Palpitations after a MAZE Procedure | ||
|Description=A 75-year-old lady presented with palpitations. Her medical history reveals cardiac surgery with a mitral valve repair combined... | |Description='''Palpitations after a MAZE Procedure'''<br/>A 75-year-old lady presented with palpitations. Her medical history reveals cardiac surgery with a mitral valve repair combined... | ||
|Contributor=A.A.M. Wilde, H.H.D. Idzerda | |Contributor=A.A.M. Wilde, H.H.D. Idzerda | ||
}} | }} | ||
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|File=Puzzle_2007_03_114_fig1.jpg | |File=Puzzle_2007_03_114_fig1.jpg | ||
|Link=Abnormal Repolarization, Spot Diagnosis? | |Link=Abnormal Repolarization, Spot Diagnosis? | ||
|Description=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... | |Description='''Abnormal Repolarization, Spot Diagnosis?'''<br/>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... | ||
|Contributor=A.A.M. Wilde, N.A. Blom | |Contributor=A.A.M. Wilde, N.A. Blom | ||
}} | }} | ||
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|File=Puzzle_2005_4_157_fig1.jpg | |File=Puzzle_2005_4_157_fig1.jpg | ||
|Link=An Irregular Rhythm at Older Age | |Link=An Irregular Rhythm at Older Age | ||
|Description=An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history... | |Description='''An Irregular Rhythm at Older Age'''<br/>An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2007_5_198_fig1.jpg | |File=Puzzle_2007_5_198_fig1.jpg | ||
|Link=Palpitations all the Time | |Link=Palpitations all the Time | ||
|Description=A 14-year-old girl complained of palpitations that occurred numerous times a week. There were no special triggers and, usually... | |Description='''Palpitations all the Time'''<br/>A 14-year-old girl complained of palpitations that occurred numerous times a week. There were no special triggers and, usually... | ||
|Contributor=A.A.M. Wilde, M. Cuppen, J.L.R.M. Smeets | |Contributor=A.A.M. Wilde, M. Cuppen, J.L.R.M. Smeets | ||
}} | }} | ||
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|File=Puzzle_2007_6_231_fig1.jpg | |File=Puzzle_2007_6_231_fig1.jpg | ||
|Link=Five Years of Palpitations | |Link=Five Years of Palpitations | ||
|Description=A 43-year-old man came to the outpatient clinic for preventive cardiovascular (CV) screening. During the last five years he... | |Description='''Five Years of Palpitations'''<br/>A 43-year-old man came to the outpatient clinic for preventive cardiovascular (CV) screening. During the last five years he... | ||
|Contributor=N.M. Panhuyzen-Goedkoop, L.R.C. Dekker, A.A.M. Wilde | |Contributor=N.M. Panhuyzen-Goedkoop, L.R.C. Dekker, A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2007_12_426_fig1.jpg | |File=Puzzle_2007_12_426_fig1.jpg | ||
|Link=An Abnormal ECG? | |Link=An Abnormal ECG? | ||
|Description=A 47-year-old lady presents with an ‘abnormal ECG’. In her family three daughters suffer from a long-QT syndrome type 2... | |Description='''An Abnormal ECG?'''<br/>A 47-year-old lady presents with an ‘abnormal ECG’. In her family three daughters suffer from a long-QT syndrome type 2... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
|} | |} | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
|- valign="top" | |- valign="top" | ||
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|File=Puzzle_2005_12_466_fig1.jpg | |File=Puzzle_2005_12_466_fig1.jpg | ||
|Link=Right You Are | |Link=Right You Are | ||
|Description=A 63-year-old female was referred to our outpatient clinic with symptoms of palpitations. These had been occurring in paroxysms... | |Description='''Right You Are'''<br/>A 63-year-old female was referred to our outpatient clinic with symptoms of palpitations. These had been occurring in paroxysms... | ||
|Contributor=T.A. Simmers, A.A.M. Wilde | |Contributor=T.A. Simmers, A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2006_1_33_fig1.jpg | |File=Puzzle_2006_1_33_fig1.jpg | ||
|Link=Should I be Worried? | |Link=Should I be Worried? | ||
|Description=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... | |Description='''Should I be Worried?'''<br/>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... | ||
|Contributor=A.A.M. Wilde, H.L. Tan | |Contributor=A.A.M. Wilde, H.L. Tan | ||
}} | }} | ||
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|File=Puzzle_2006_3_108_fig1.jpg | |File=Puzzle_2006_3_108_fig1.jpg | ||
|Link=A Pre-excited Wide QRS Complex: is That all There is? | |Link=A Pre-excited Wide QRS Complex: is That all There is? | ||
|Description=A 28-year-old male was referred because of an abnormal ECG. He was having occasional palpitations. His family history is unremarkable... | |Description='''A Pre-excited Wide QRS Complex: is That all There is?'''<br/>A 28-year-old male was referred because of an abnormal ECG. He was having occasional palpitations. His family history is unremarkable... | ||
|Contributor=A.A.M. Wilde, L.R.C. Dekker | |Contributor=A.A.M. Wilde, L.R.C. Dekker | ||
}} | }} | ||
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|File=Puzzle_2006_4_154_fig1.jpg | |File=Puzzle_2006_4_154_fig1.jpg | ||
|Link=An Old Lady with Chest Pain | |Link=An Old Lady with Chest Pain | ||
|Description=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... | |Description='''An Old Lady with Chest Pain'''<br/>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... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2005_5_189_fig1.jpg | |File=Puzzle_2005_5_189_fig1.jpg | ||
|Link=Palpitations and Dizziness in a 65-Year-Old-Man | |Link=Palpitations and Dizziness in a 65-Year-Old-Man | ||
|Description=A 65-year-old male presented with palpitations and dizziness of sudden onset, without any associated chest pain or other symptoms... | |Description='''Palpitations and Dizziness in a 65-Year-Old-Man'''<br/>A 65-year-old male presented with palpitations and dizziness of sudden onset, without any associated chest pain or other symptoms... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2006_08_268_fig1.jpg | |File=Puzzle_2006_08_268_fig1.jpg | ||
|Link=A Narrow QRS Complex Tachycardia Sensitive to Isoptin | |Link=A Narrow QRS Complex Tachycardia Sensitive to Isoptin | ||
|Description=A 54-year-old man presented with palpitations. He had no other symptoms. Physical examination revealed, with the exception of a... | |Description='''A Narrow QRS Complex Tachycardia Sensitive to Isoptin'''<br/>A 54-year-old man presented with palpitations. He had no other symptoms. Physical examination revealed, with the exception of a... | ||
|Contributor=A.A.M. Wilde, R.H. Bakker | |Contributor=A.A.M. Wilde, R.H. Bakker | ||
}} | }} | ||
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|File=Puzzle_2006_9_315_fig1.jpg | |File=Puzzle_2006_9_315_fig1.jpg | ||
|Link=And What About the ECG? | |Link=And What About the ECG? | ||
|Description=A 63-year-old lady presented with episodic chest pain without specific triggers (in particular no relation with exercise)... | |Description='''And What About the ECG?'''<br/>A 63-year-old lady presented with episodic chest pain without specific triggers (in particular no relation with exercise)... | ||
|Contributor=A.A.M. Wilde, R.H.J. Peters | |Contributor=A.A.M. Wilde, R.H.J. Peters | ||
}} | }} | ||
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|File=Puzzle_2006_11_393_fig1.jpg | |File=Puzzle_2006_11_393_fig1.jpg | ||
|Link=Palpitations Again, Have a Closer Look | |Link=Palpitations Again, Have a Closer Look | ||
|Description=An otherwise healthy 57-year-old lady presented with palpitations without dizziness. The symptoms had been present for a couple... | |Description='''Palpitations Again, Have a Closer Look'''<br/>An otherwise healthy 57-year-old lady presented with palpitations without dizziness. The symptoms had been present for a couple... | ||
|Contributor=A.A.M. Wilde, L.R.C. Dekker | |Contributor=A.A.M. Wilde, L.R.C. Dekker | ||
}} | }} | ||
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|File=Puzzle_2006_12_436_fig1.jpg | |File=Puzzle_2006_12_436_fig1.jpg | ||
|Link=Wide Complexes Intervening Regular Sinus Rhythm | |Link=Wide Complexes Intervening Regular Sinus Rhythm | ||
|Description=A 28-year-old, wheelchair bound, female patient with Friedreich’s ataxia presents with an irregular heartbeat... | |Description='''Wide Complexes Intervening Regular Sinus Rhythm'''<br/>A 28-year-old, wheelchair bound, female patient with Friedreich’s ataxia presents with an irregular heartbeat... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
|} | |} | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
|- valign="top" | |- valign="top" | ||
Line 262: | Line 407: | ||
|File=Puzzle_2005_1_23_fig1.jpg | |File=Puzzle_2005_1_23_fig1.jpg | ||
|Link=ECG puzzle: Appearances Can be Deceiving | |Link=ECG puzzle: Appearances Can be Deceiving | ||
|Description=A 61-year-old male was referred with symtoms of exertional dyspnoea and palpitations. He had suffered an anterior myocardial... | |Description='''ECG puzzle: Appearances Can be Deceiving'''<br/>A 61-year-old male was referred with symtoms of exertional dyspnoea and palpitations. He had suffered an anterior myocardial... | ||
|Contributor=T.A. Simmers | |Contributor=T.A. Simmers | ||
}} | }} | ||
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|File=Puzzle_2005_2_67_fig1.jpg | |File=Puzzle_2005_2_67_fig1.jpg | ||
|Link=Where Do the Extras Come From? | |Link=Where Do the Extras Come From? | ||
|Description=A 64-year-old man had an inferior myocardial infarction ten years ago. Lately he has been having palpitations with occasional dizziness... | |Description='''Where Do the Extras Come From?'''<br/>A 64-year-old man had an inferior myocardial infarction ten years ago. Lately he has been having palpitations with occasional dizziness... | ||
|Contributor=A.A.M. Wilde, R.B.A. van den Brink | |Contributor=A.A.M. Wilde, R.B.A. van den Brink | ||
}} | }} | ||
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|File=Puzzle_2005_4_156_fig1.jpg | |File=Puzzle_2005_4_156_fig1.jpg | ||
|Link='The Turtle and the Hare' | |Link='The Turtle and the Hare' | ||
|Description=An otherwise healthy 32-year-old male was referred with palpitations. Attacks had been occurring monthly for several years... | |Description='''The Turtle and the Hare'''<br/>An otherwise healthy 32-year-old male was referred with palpitations. Attacks had been occurring monthly for several years... | ||
|Contributor=A.A.M. Wilde, R.B.A. van den Brink | |Contributor=A.A.M. Wilde, R.B.A. van den Brink | ||
}} | }} | ||
Line 281: | Line 426: | ||
|File=Puzzle_2005_5_195_fig1.jpg | |File=Puzzle_2005_5_195_fig1.jpg | ||
|Link=Now You See it, Now You Don't | |Link=Now You See it, Now You Don't | ||
|Description=An otherwise healthy 66-year-old male was referred with complaints of central chest pain. He was not on any medication... | |Description='''Now You See it, Now You Don't'''<br/>An otherwise healthy 66-year-old male was referred with complaints of central chest pain. He was not on any medication... | ||
|Contributor=T.A. Simmers, A.A.M. Wilde | |Contributor=T.A. Simmers, A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2005_6_244_fig1.jpg | |File=Puzzle_2005_6_244_fig1.jpg | ||
|Link=It's Not What You Think it Is | |Link=It's Not What You Think it Is | ||
|Description=A 20-year-old male is having palpitations. They occur without a specific trigger, although episodes are sometimes related to... | |Description='''It's Not What You Think it Is'''<br/>A 20-year-old male is having palpitations. They occur without a specific trigger, although episodes are sometimes related to... | ||
|Contributor=A.A.M. Wilde, R.B.A. van den Brink | |Contributor=A.A.M. Wilde, R.B.A. van den Brink | ||
}} | }} | ||
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|File=Puzzle_2005_8_285_fig1.jpg | |File=Puzzle_2005_8_285_fig1.jpg | ||
|Link=One is Enough, Two is Too Many | |Link=One is Enough, Two is Too Many | ||
|Description=An otherwise healthy 24-year-old man was referred to our hospital because of drug refractory spells of palpitations accompanied by dizziness... | |Description='''One is Enough, Two is Too Many'''<br/>An otherwise healthy 24-year-old man was referred to our hospital because of drug refractory spells of palpitations accompanied by dizziness... | ||
|Contributor=A.A.M. Wilde, R.B.A. van den Brink | |Contributor=A.A.M. Wilde, R.B.A. van den Brink | ||
}} | }} | ||
Line 300: | Line 445: | ||
|File=Puzzle_2005_10_373_fig1.jpg | |File=Puzzle_2005_10_373_fig1.jpg | ||
|Link=The ECG of a (Cardio)myopathy? | |Link=The ECG of a (Cardio)myopathy? | ||
|Description=A 33-year-old lady visited the cardiologist because of the sudden death of her brother at age 35. He died while watching TV... | |Description='''The ECG of a (Cardio)myopathy?'''<br/>A 33-year-old lady visited the cardiologist because of the sudden death of her brother at age 35. He died while watching TV... | ||
|Contributor=A.A.M. Wilde, Y.M. Pinto | |Contributor=A.A.M. Wilde, Y.M. Pinto | ||
}} | }} | ||
Line 306: | Line 451: | ||
|File=Puzzle_2005_11_428_fig1.jpg | |File=Puzzle_2005_11_428_fig1.jpg | ||
|Link=The Ions Have It | |Link=The Ions Have It | ||
|Description=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 | |Description='''The Ions Have It'''<br/>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 | ||
|Contributor=T.A. Simmers, A.A.M. Wilde | |Contributor=T.A. Simmers, A.A.M. Wilde | ||
}} | }} | ||
|} | |} | ||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | {| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | ||
|- valign="top" | |- valign="top" | ||
Line 317: | Line 460: | ||
|File=Puzzle_2004_2_73.jpg | |File=Puzzle_2004_2_73.jpg | ||
|Link=A fainting lady with some extrasystoles | |Link=A fainting lady with some extrasystoles | ||
|Description=A 30-year-old woman presents with repeated syncope. Her symptoms started a few months ago without a particular trigger... | |Description='''A fainting lady with some extrasystoles'''<br/>A 30-year-old woman presents with repeated syncope. Her symptoms started a few months ago without a particular trigger... | ||
|Contributor=A.A.M. Wilde and H. Tan | |Contributor=A.A.M. Wilde and H. Tan | ||
}} | }} | ||
Line 323: | Line 466: | ||
|File=Puzzle_2004_4_178_fig1.jpg | |File=Puzzle_2004_4_178_fig1.jpg | ||
|Link=Syncopated Rhythm | |Link=Syncopated Rhythm | ||
|Description=A 65-year-old woman was admitted because of recurrent syncope. Her complaints were difficult to interpret due to mental... | |Description='''Syncopated Rhythm'''<br/>A 65-year-old woman was admitted because of recurrent syncope. Her complaints were difficult to interpret due to mental... | ||
|Contributor=L.R.C. Dekker, R. Tukkie | |Contributor=L.R.C. Dekker, R. Tukkie | ||
}} | }} | ||
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|File=Puzzle_2007_4_157_fig1.jpg | |File=Puzzle_2007_4_157_fig1.jpg | ||
|Link=Rhythm Puzzle: An Irregular Rhythm at Older Age | |Link=Rhythm Puzzle: An Irregular Rhythm at Older Age | ||
|Description=An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history... | |Description='''An Irregular Rhythm at Older Age'''<br/>An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history... | ||
|Contributor=A.A.M. Wilde | |Contributor=A.A.M. Wilde | ||
}} | }} | ||
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|File=Puzzle_2004_6_302_fig1.jpg | |File=Puzzle_2004_6_302_fig1.jpg | ||
|Link=I Think a Niece of Mine was Referred to a Neurologist | |Link=I Think a Niece of Mine was Referred to a Neurologist | ||
|Description=In the setting of family screening, an 84-year-old lady was invited for a cardiogenetic evaluation. Two of her grandchildren... | |Description='''I Think a Niece of Mine was Referred to a Neurologist'''<br/>In the setting of family screening, an 84-year-old lady was invited for a cardiogenetic evaluation. Two of her grandchildren... | ||
|Contributor=A.A.M. Wilde, T.A. Simmers | |Contributor=A.A.M. Wilde, T.A. Simmers | ||
}} | }} | ||
Line 342: | Line 485: | ||
|File=Nhj_2004_8_355.jpg | |File=Nhj_2004_8_355.jpg | ||
|Link=Just One Collapse During Soccer | |Link=Just One Collapse During Soccer | ||
|Description=A 14-year-old boy died suddenly while playing soccer. He was in the middle of a sprint when he suddenly succumbed... | |Description='''Just One Collapse During Soccer'''<br/>A 14-year-old boy died suddenly while playing soccer. He was in the middle of a sprint when he suddenly succumbed... | ||
|Contributor=A.A.M. Wilde, T.A. Simmers | |Contributor=A.A.M. Wilde, T.A. Simmers | ||
}} | }} | ||
Line 348: | Line 491: | ||
|File=Puzzle_2004_10_469_fig1.png | |File=Puzzle_2004_10_469_fig1.png | ||
|Link=Tachycardia Terminated by Adenosine | |Link=Tachycardia Terminated by Adenosine | ||
|Description=A 27-year-old female was referred to the emergency room with rapid palpitations... | |Description='''Tachycardia Terminated by Adenosine'''<br/>A 27-year-old female was referred to the emergency room with rapid palpitations... | ||
|Contributor=I.C.D. Westendorp, G.S. de Ruiter, L.V.A. Boersma, E.F.D. Wever | |Contributor=I.C.D. Westendorp, G.S. de Ruiter, L.V.A. Boersma, E.F.D. Wever | ||
}} | }} | ||
|- valign="top" | |- valign="top" | ||
{{Smallcase| | {{Smallcase| | ||
|File= | |File=Nhj_2004_11_510-1.jpg | ||
|Link=Nightly Phenomena, Day Time Work? | |Link=Nightly Phenomena, Day Time Work? | ||
|Desctitle=Nightly Phenomena, Day Time Work? | |||
|Description=In 2002, an a trial demand inhibited (AAI) pacemaker was implanted in a young male (born 1984) because of a primary arrhythmia disorder. | |Description=In 2002, an a trial demand inhibited (AAI) pacemaker was implanted in a young male (born 1984) because of a primary arrhythmia disorder. | ||
|Contributor=R. Tukkie, R. Rienks, A.A.M. Wilde | |Contributor=R. Tukkie, R. Rienks, A.A.M. Wilde | ||
}} | }} | ||
|} | |} | ||
==Case reports by W.G. De Voogt, MD, PhD== | |||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=DVA0003.jpg | |||
|Link=DV Case 3 | |||
|Description='''Case: what kind of block?'''<br/>This Holter registration shows pauses. | |||
|Contributor=W.G. De Voogt, MD, PhD | |||
}} | |||
{{Smallcase| | |||
|File=DVA0004.jpg | |||
|Link=DV Case 4 | |||
|Description='''Case: a slow heart rate'''<br/>This ECG shows pauses in the heart rhythm. | |||
|Contributor=W.G. De Voogt, MD, PhD | |||
}} | |||
{{Smallcase| | |||
|File=DVA0005.jpg | |||
|Link=DV Case 5 | |||
|Description='''Case: a pause in the heart rate'''<br/>This tracing shows a pause in the heart rhythm. | |||
|Contributor=W.G. De Voogt, MD, PhD | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=DVA0006.jpg | |||
|Link=DV Case 6 | |||
|Description='''Case: fever with arrhythmias'''<br/>This is a tracing of a 52 year old male, with viral infection and high fever (40° C), who was admitted to the... | |||
|Contributor=W.G. De Voogt, MD, PhD | |||
}} | |||
|} | |||
==Case reports from the ICBA== | |||
{| width="100%" cellspacing="10" style="font-size: 90%;padding: 3px; " | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=ICBA00001.jpg | |||
|Link=ICBA1 | |||
|Description='''Fusion beats'''<br/>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. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00002.jpg | |||
|Link=ICBA2 | |||
|Description='''LBBB and RBBB'''<br/>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. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00003.jpg | |||
|Link=ICBA3 | |||
|Description='''Fusion beats'''<br/>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. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{ | |- valign="top" | ||
== | {{Smallcase| | ||
|File=ICBA00004.jpg | |||
|Link=ICBA4 | |||
|Description='''Escape beats'''<br/>Sinus rythm, high degree AV block with unional escape beats and capture beats with RBBB. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00008.jpg | |||
|Link=ICBA5 | |||
|Description='''Orthodromic tachycardia in WPW'''<br/>AV orthodromic tachycardia (WPW syndrome). | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00010.jpg | |||
|Link=ICBA6 | |||
|Description='''Ventricular tachcyardia'''<br/>Ventricular tachycardia or idioventricular rythm during sinus tachycardia with fusion beats. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | }} | ||
|- valign="top" | |||
{{Smallcase| | |||
|File=ICBA00005.jpg | |||
|Link=ICBA7 | |||
|Description='''Escape rhythm with RBBB pattern'''<br/> | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00006.jpg | |||
|Link=ICBA8 | |||
|Description='''Escape rhythm with LBBB pattern'''<br/>Escape rhythm with left bundle branch block pattern and likely retrograde conducted P waves. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00007.jpg | |||
|Link=ICBA9 | |||
|Description='''Intermittent pre-exitation'''<br/>Intermittent pre-exitation | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=ICBA00009.jpg | |||
|Link=ICBA10 | |||
|Description='''Sinus irregularity'''<br/>SA exit block | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00011.jpg | |||
|Link=ICBA11 | |||
|Description='''Complete AV block and left ventricle escape'''<br/>Complete AV block and left ventricle escape. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00012.jpg | |||
|Link=ICBA12 | |||
|Description='''Idionodal escape rythm and ventricular capture by AV nodal reentry'''<br/>Idionodal escape rythm and ventricular capture by AV nodal reentry... | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=ICBA00013.jpg | |||
|Link=ICBA13 | |||
|Description='''Idioventricular rythm with 1:1 V-A conduction'''<br/>Idioventricular rythm with 1:1 V-A conduction. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00014.jpg | |||
|Link=ICBA14 | |||
|Description='''Mobitz II AV block with LBBB in the conducted beats'''<br/>Mobitz II AV block with LBBB in the conducted beats. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00015.jpg | |||
|Link=ICBA15 | |||
|Description='''Idioventricular accelerated rythm with fusion beats'''<br/>Idioventricular accelerated rythm with fusion beats. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=ICBA00016.jpg | |||
|Link=ICBA16 | |||
|Description='''AV nodal reentry tachycardia'''<br/>AV nodal reentry tachycardia. Also look at the below ladder diagram. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00017.jpg | |||
|Link=ICBA17 | |||
|Description='''3:1 AV block with idionodal escape (the third P wave is inside the QRS)'''<br/>AV block with idionodal escape (the third P wave is inside the QRS). | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00018.jpg | |||
|Link=ICBA18 | |||
|Description='''Sinus bradicardia and isorythmic nodal escapes'''<br/>Sinus bradicardia and isorythmic nodal escapes. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
|- valign="top" | |||
{{Smallcase| | |||
|File=ICBA00019.jpg | |||
|Link=ICBA19 | |||
|Description='''Coarse atrial fibrillation mimic atrial flutter'''<br/>Coarse atrial fibrillation mimic atrial flutter. | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00020.jpg | |||
|Link=ICBA20 | |||
|Description='''Long QT and VPB secondary to sotalol administration'''<br/>Long QT and VPB secondary to sotalol administration | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
{{Smallcase| | |||
|File=ICBA00023.jpg | |||
|Link=ICBA21 | |||
|Description='''Intermittent WPW'''<br/>Intermittent WPW | |||
|Contributor=Dr. Alberto Giniger | |||
}} | |||
|} |