EKG Workshop -
Beyond the Basics
Dr. Ross MacKenzie FRCPC FACC
2012 AAIM Annual Meeting – San Diego 1
ECG Workshop
Objectives:
•Beyond the basics
•Common ECG underwriting challenges
•Newer ECG patterns with mortality implications
•Focus on ECG morphology
2
Asymptomatic 42 year old female
4
Baseline ECG Right Arm/Right Leg Exchange
Right Arm/Right Leg Lead Exchange
5
Left Arm/Right Leg Lead Reversal
Baseline ECG Left Arm/Right Leg Reversal
6
Bilateral Arm-Leg Lead Reversal
Baseline ECG Bilateral Arm-Leg Lead Reversal
48 Year Old Man With a Pacemaker for Congenital Heart Block
8
LBBB Pattern Produced by Proper Pacemaker
Catheter Position in RV Apex
9
55 Y. O. Male - PH of Possible MI - Pre-ex. Test ECG
10
Mason Likar Exercise ECG Electrode Placement Configuration
11
Standard ECG Showing Previous Inferior Myocardial Infarction
12
47 Year Old Man with History of Previous MI
Asymptomatic 54 Year Old Male Applicant
13
56 Year Old Male Entrepreneur Who Had Chest Discomfort One Year Ago While
Travelling in Southeast Asia
41 Y. O. Man - History of Erythema Nodosum Age 14
Fragmented QRS Patterns
38-year old stockbroker – ECG for “age and amount”
Courtesy of Dr. M. Clark
18
ECG from 5 years prior to the application
Courtesy of Dr. M. Clark
19
Horizontal Vector Loop of Normal R wave Progression
20
Anteroseptal Infarction
Horizontal Plane
21
Left Ventricular Hypertrophy
Horizontal Plane
22
The P Wave in V2 and Technical Errors Recording the Chest
Leads
23
Changing P-Wave Morphology in Lead V2
Ilg KJ, et al, Am J Med 2012; 125:23.
49 year old woman who had a severe episode of gastroenteritis after climbing Mount
Kilimanjaro in Tanzania
25
Dilated Cardiomyopathy
26
40 year old asymptomatic male applicant
36 year old asymptomatic male college basketball coach
36 year old asymptomatic male
29
Normal Precordial ST Segment Elevation
24 year old woman with history of palpitations
32
Ebstein’s Anomaly
33
32 year old male with systolic murmur at the apex
34
Primum Atrial Septal Defect Secundum Atrial Septal Defect
Secundum Atrial Septal Defect
35
36
The “Crochetage Sign “ in Atrial Septal Defects
40 Year Old Male – Tetralogy of Fallot Repair Age 5
25 year old asymptomatic male
Brugada ECG Patterns
Brugada Type 1 Pattern
40
Borderline Brugada PatternDrug Challenge
Saddleback Pattern Changes When V1 and V2 Are Moved To The Second and Third
Intercostal space (V2IC2 and V2IC3) Overlying the Right Ventricular Outflow Tract
Meregalli P G et al. Cardiovasc Res 2005;67:367-378
46 year old asymptomatic college professor
43
44
Incidence of T wave Inversion Beyond V1 and V2
In ages 19-45
< 4% in women
< 1% in men
In middle-aged subjects 36-50
< 0.7%
Marcus F. Am J Cardiol 2005; 95:1070
Aro AL. Circulation 2012; 125:1272
21 year old asymptomatic male
45
25 year old asymptomatic male
46
47
Epsilon Wave
