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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" | ||
Line 109: | Line 260: | ||
}} | }} | ||
|} | |} | ||
{| 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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}} | }} | ||
|} | |} | ||
{| 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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|} | |} | ||
{| 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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|} | |} | ||
{| 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 310: | Line 455: | ||
}} | }} | ||
|} | |} | ||
{| 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=DVA0003.jpg | |File=DVA0003.jpg | ||
|Link=DV Case 3 | |Link=DV Case 3 | ||
|Description=''' | |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 | |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 | |||
}} | |||
|} |