Archive for the ECG of the week Category

aVR – Gets no respect

Watch this interesting video by the influential Dr Amal Mattu. This would change your views about aVR.

Click here to watch the video


This patient presented with syncope. What are the abnormalities on the ECG?



Answer:[expand title=”Open” swaptitle=”Close”]

•Sinus bradycardia
•RBBB block (note RSR’ V1-V4 with associated repolarisation abnormality and S wave in V6)
•LAHB with marked left axis deviation

These findings raise the possibility of a transient high degree AV block causing the syncope.[/expand]

Syncope, otherwise normal….

32 yrs old female, presented to ED for one episode of fainting, witnessed by husband. Loss of consciousness few seconds. No hx of headache or chest pain associated with syncope. No previous syncopal episodes, but had few episodes of self resolved palpitations, not investigated further. On examination, vitals stable, looked well. Blood results were unremarkable. This is her ECG; What do you think is the problem? What is the pathophysiology? What is the definitive treatment? (Please use the “Leave a reply”  section below to post your answer)

Unusual presentation….

An otherwise well 60 year old man, DC, presents with palpitations whilst out walking three hours ago.  He admits to mild chest tightness.  He denies any history of fever, cough, chest pain or breathlessness.  A 12 lead ECG is taken and is as below.  What is the rhythm?  How can you be sure? How will you treat it?








(Click on the image to enlarge)

What happened next? [expand title=”Open” swaptitle=”Close”]

DC continues to feel palpitations and mild chest tightness.  He is given oxygen and put into Resuscitation, where 6mg of IV adenosine via  a cannula in his cubital fossa confirms that he is in atrial flutter.  His chest tightness persists despite oxygen and half an anginine.  His BP is 100/65.  As he has eaten recently but has only been in atrial flutter for a few hours, he is sedated with ketamine and cardioverted to sinus rhythm with 50 joules.








Give it a try….

What do you think about this ECG? Can you describe and interpret? Click on the image to enlarge.
(use the comment link at the bottom to post your answers)