Advanced EKG patterns

Upper Level ConferenceUNC Internal Medicine

10/21/09

Basics

• Always examine an EKG systematically then come up with your interpretation

LVH1.What are the criteria for LVH?

What is the abnormality?

Left Anterior Fascicular Block1. Criteria for LAFB?

What is the axis?What is the differential diagnosis for that axis?

What rhythm is this? How do you know?

Describe this rhythm using your “tachycardia” algorithm:

Any regular wide complex tachydardia:

• Brugada Criteria – helps you discern between VT and SVT with aberrancy

• If ANY of the criteria are satisfied, its VT• If NO criteria is satisfied, its SVT with

aberrancy

Brugada criteria

1. Concordance in precordial leads2. R to S interval > 100ms in a precordial lead3. AV dissociation?4. Morphology look like VT?

Concordance (lack of RS complex in precordial leads)

What are the abnormalities?

Brugada syndrome – Inherited Na channel abnormality, can lead to sudden death

What is the syndrome?

In summary

• Formal diagnosis of LVH• LAFB and LPFB• Approach to tachycardia• Distinguish between VT and SVT with

aberrancy – Brugada criteria• Brugada syndrome