The classics: Top 12 ECGs of 2022 (Part 3)
ECG Experts Uncover their Most Fascinating ECG Cases of the Year
This is Part 3 of this exciting ECG series. This week, we have compiled crucial ECG patterns that every healthcare professional in emergency care should be able to identify.
Use the following quick links to navigate to the expert ECG cases quickly:
Nicholas Peschanski’s ECG: 55F’s mother with crushing chest pain.
Amal Mattu’s ECG: 60M with acute onset chest pain.
Kashif Chaudhry’s ECG: High metoprolol dosage?
Don’t forget to go through Part 1 and Part 2 ECG cases first.
1. Nicolas Peschanski (@DocNikko)
Background
A 55-year-old woman’s daughter calls the SAMU (French 911) for her mother suffering crushing chest pain with diaphoresis for one hour.
The following ECG is recorded. Can you spot the picture book pattern?
Expert breakdown
The paramedic team on-scene record the following ECG and send a photo to the medical call center’s computer network. I digitized it and immediately called my colleagues on-scene to describe the high risk of cardiogenic shock with this “shark-fin” ECG pattern revealing a proximal LAD occlusion.
Indeed, the blood pressure of the patient dropped within minutes, and she was admitted for ECMO in cardiac surgery ICU immediately after the angiography showing a 100% occluded proximal LAD occlusion with TIMI 0 flow and a severely reduced left ventricular ejection fraction of 15%!
Later, I taught to my resident about this case and this very peculiar “shark-fin” or “lambda” ECG pattern that you need to know because of the associated poor prognosis and aggressive hemodynamic support that needs to be anticipated.
Meet Nikko
Nicolas Peschanski, MD, is a professor of emergency medicine and a hospital practitioner at the University Hospital of Rennes. He is a committed driver of the Free Open Access Meducation (FOAMed) principle and an active social medical contributor posting educational and knowledge content focusing on emergency medicine.
2. Amal Mattu (@ECGWeekly)
Background
A 60-year-old man is brought into the emergency department by EMS for acute onset chest pain and diaphoresis concerning for an acute coronary syndrome. The following ECG is obtained on arrival:
Expert breakdown
Listen to the expert breakdown of this compelling case here by clicking the image or text: Amal Mattu’s ECG Case of the Week – November 7, 2022 – ECG Weekly.
Meet Amal
Amal Mattu, MD, is the author of 16 textbooks in emergency medicine, including seven focused on emergency cardiology and electrocardiography. Dr. Mattu is currently a tenured professor, Vice Chair, and director of the Emergency Cardiology Fellowship for the Department of Emergency Medicine at the University of Maryland School of Medicine.
3. Kashif Chaudhry (@KashifMD)
Background
Kashif received an ECG from a patient with the following comments by the referring physician:
"No wonder you are lightheaded. Your heart rate is just 53. Let us cut your metoprolol down from 100 to 50mg twice daily and have you see cardiology in a few days."
What do you think? 53 bpm?
Expert breakdown
Ectopic atrial rhythm
Complete heart block
Escape rhythm has RBB/LPF morphology, likely focus in the LAF.
The atrial activity is unlikely to be sinus given p wave morphology. The computer mistakes the baseline P waves for “PVCs.” The PR interval preceding the QRS complexes is not constant (increased by 40ms).
See how this case evolved on Twitter:
Bonus: AI-powered ECG Interpretation
This is how the PMcardio — ECG Analysis smartphone app interpreted the tracing.
How would you rate this AI-powered interpretation?
Meet Kashif
Kashif Chaudhry, MD, is the director of cardiac electrophysiology at the UPMC Williamsport hospital in Pennsylvania, United States. Kashif's interests include Electrophysiology, Human Rights, and the fight for universal freedom of conscience.
If you liked this Part, please check out Part 1 and Part 2 of the series, where experts unveil their favorite ECGs of 2022.
Robert Herman, MD, is a physician and scientist with a background in technology and expertise in AI and machine learning. He is the Co-founder of Powerful Medical, where he serves as the Chief Medical Officer and leads the research and clinical evaluation of AI-powered medical devices for diagnosing and managing cardiovascular diseases.
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When does the United States PMcardio app get released? Does anyone know?