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Rhythm strip in AJR: Narrow complex rhythm; inverted retrograde P waves seen before the QRS complex
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Slow-Fast (Typical) AVNRT:
Narrow complex tachycardia at ~ 150 bpm
No visible P waves
There are pseudo R’ waves in V1-2
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Middle aged patient presenting with chest pain and diaphoresis.
What does the ECG show?
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70-year old patient presenting with chest pain and diaphoresis. Describe the ECG.
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This is the classic picture of digoxin effect, with “sagging” ST segments and T waves taking on the appearance of “Salvador Dali’s moustache“
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Digoxin effect refers to the presence on the ECG of:
Downsloping ST depression with a characteristic “reverse tick” or “Salvador Dali sagging” appearance
Flattened, inverted, or biphasic T waves
Shortened QT interval
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Sagging ST depression is clearly evident in leads I, II, III, aVF and V5-6
Frequent premature ventricular complexes (PVCs) suggest the possibility of digoxin toxicity
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Downsloping TP segment seen as an early ECG manifestation in ~30% of patients with pericarditis, best visualised in leads II and the lateral precordial leads
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Example 2: Pericarditis
ST-segment-T-wave-ratio-pericarditis
ST segment height = 2 mm
T wave height = 4 mm
ST / T wave ratio = 0.5
The ST / T wave ratio > 0.25 is consistent with pericarditis.
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Benign Early Repolarisation
ST-segment-T-wave-ratio-Benign Early Repolarisation
ST segment height = 1 mm
T wave height = 6 mm
ST / T wave ratio = 0.16
The ST / T wave ratio < 0.25 is consistent with BER
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78 yr old male presents with a 2 day history of lethargy and dizziness. He has a history of ischaemic heart disease, type 2 diabetes, hypertension, and chronic renal failure. His medications include calcium-channel blocker, beta-blocker, and ACE-inhibitor.
He is conscious with systolic BP of 70.
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