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.
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.
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...
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...
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...
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
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
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...
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...
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...
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...
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...
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...
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...
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
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...
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...
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...
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...
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...
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...
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...
Wide Complexes Intervening Regular Sinus Rhythm A 28-year-old, wheelchair bound, female patient with Friedreich’s ataxia presents with an irregular heartbeat...
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...
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
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...
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
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
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...
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
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...
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...
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 I.C.D. Westendorp, G.S. de Ruiter, L.V.A. Boersma, E.F.D. Wever
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.
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.
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.
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.