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ECG QUIZ
PROF(DR).G.SUNDARAMURTHY
M2 UNIT
DR.DILIP HARINDRAN
SECOND YEAR PG RESIDENT
PRESENTATION
• A 73 YEAR OLD MALE CAME WITH
COMPLAINTS OF DIFFICULTY IN USING LEFT
UPPER LIMB AND LOWER LIMB SINCE
MORNING. A KNOWN DIABETIC AND
HYPERTENSIVE.
• O/E PR - 64/MIN, BP - 160/100 MM HG,
GCS -8/15 CNS - LEFT HEMIPLEGIA.
• ECG WAS TAKEN FOR THE PATIENT WHICH
SHOWED,
ECG: Findings in CNS disorders
INTERPRETATION
• NORMAL SINUS RHYTHM
• RATE - 75/MIN
• P WAVE - NORMAL MORPHOLOGY, REDUCED
VOLTAGE IN LIMB LEADS
• PR INTERVAL NORMAL
• QRS COMPLEX NORMAL MORPHOLOGY, LOW
VOLTAGE IN LIMB LEADS
• QT INTERVAL PROLONGED - 500MS AND DEEP
ANTEROLATERAL T WAVE INVERSIONS (CAN BE DUE
TO CNS INVOLVEMENT OR MYOCARDIAL
ISCHEMIA).
DISCUSSION
• ECG FINDINGS OF ACUTE CNS DISORDERS
INCLUDE:
1. LARGE UPRIGHT T WAVES IN PRECORDIAL LEADS
2. INCREASED QRS VOLTAGE
3. DEEPLY INVERTED T WAVES IN PRECORDIAL
LEADS
4. PROLONGED QT INTERVAL
5. PROMINENT U WAVES IN PRECORDIAL LEADS
• OTHERS FINDINGS INCLUDE:
1. T WAVE NOTCHING
2. LOSS T WAVE AMPLITUDE
3. DIFFUSE ST SEGMENT ELEVATION
4. ABNORMAL Q WAVES
5. RHYTHM ABNORMALITIES LIKE AF, VT, SINUS
BRADYCARDIA OR TACHYCARDIA CAN
OCCUR.
• ECG CHANGES ASSOCIATED WITH ACUTE CNS
EVENTS CAN MIMIC -
1. ACUTE MYOCARDIAL INFARCTION
2. LEFT VENTRICULAR HYPERTROPHY
3. RIGHT VENTRICULAR HYPERTROPHY
4. PERICARDITIS
5. ANTIARRHYTHMIC DRUG EFFCTS
FIND THE IMPOSTER
ANSWER
• TRACINGS A, B AND C SHOW ATRIAL FIBRILLATION
WITH IRREGULARLY IRREGULAR RHYTHMS;
FIBRILLATORY WAVES OF VARYING AMPLITUDE AND
MORPHOLOGY; ABSENCE OF DISCRETE P WAVES.
• TRACING D SHOWS MAT. IT USUALLY PRESENTS
WITH ATRIAL RATE OF >100BPM, 3 OR MORE
DIFFERENT P WAVE MORPHOLOGIES, AND VARYING
PP AND PR INTERVAL. DEFINITE P WAVES AND
ATRIAL DEPOLARIZATIONS ARE NOTED WHICH ARE
NOT THERE IN A, B AND C.
ECG: Findings in CNS disorders

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ECG: Findings in CNS disorders

  • 1. ECG QUIZ PROF(DR).G.SUNDARAMURTHY M2 UNIT DR.DILIP HARINDRAN SECOND YEAR PG RESIDENT
  • 2. PRESENTATION • A 73 YEAR OLD MALE CAME WITH COMPLAINTS OF DIFFICULTY IN USING LEFT UPPER LIMB AND LOWER LIMB SINCE MORNING. A KNOWN DIABETIC AND HYPERTENSIVE. • O/E PR - 64/MIN, BP - 160/100 MM HG, GCS -8/15 CNS - LEFT HEMIPLEGIA. • ECG WAS TAKEN FOR THE PATIENT WHICH SHOWED,
  • 4. INTERPRETATION • NORMAL SINUS RHYTHM • RATE - 75/MIN • P WAVE - NORMAL MORPHOLOGY, REDUCED VOLTAGE IN LIMB LEADS • PR INTERVAL NORMAL • QRS COMPLEX NORMAL MORPHOLOGY, LOW VOLTAGE IN LIMB LEADS • QT INTERVAL PROLONGED - 500MS AND DEEP ANTEROLATERAL T WAVE INVERSIONS (CAN BE DUE TO CNS INVOLVEMENT OR MYOCARDIAL ISCHEMIA).
  • 5. DISCUSSION • ECG FINDINGS OF ACUTE CNS DISORDERS INCLUDE: 1. LARGE UPRIGHT T WAVES IN PRECORDIAL LEADS 2. INCREASED QRS VOLTAGE 3. DEEPLY INVERTED T WAVES IN PRECORDIAL LEADS 4. PROLONGED QT INTERVAL 5. PROMINENT U WAVES IN PRECORDIAL LEADS
  • 6. • OTHERS FINDINGS INCLUDE: 1. T WAVE NOTCHING 2. LOSS T WAVE AMPLITUDE 3. DIFFUSE ST SEGMENT ELEVATION 4. ABNORMAL Q WAVES 5. RHYTHM ABNORMALITIES LIKE AF, VT, SINUS BRADYCARDIA OR TACHYCARDIA CAN OCCUR.
  • 7. • ECG CHANGES ASSOCIATED WITH ACUTE CNS EVENTS CAN MIMIC - 1. ACUTE MYOCARDIAL INFARCTION 2. LEFT VENTRICULAR HYPERTROPHY 3. RIGHT VENTRICULAR HYPERTROPHY 4. PERICARDITIS 5. ANTIARRHYTHMIC DRUG EFFCTS
  • 9. ANSWER • TRACINGS A, B AND C SHOW ATRIAL FIBRILLATION WITH IRREGULARLY IRREGULAR RHYTHMS; FIBRILLATORY WAVES OF VARYING AMPLITUDE AND MORPHOLOGY; ABSENCE OF DISCRETE P WAVES. • TRACING D SHOWS MAT. IT USUALLY PRESENTS WITH ATRIAL RATE OF >100BPM, 3 OR MORE DIFFERENT P WAVE MORPHOLOGIES, AND VARYING PP AND PR INTERVAL. DEFINITE P WAVES AND ATRIAL DEPOLARIZATIONS ARE NOTED WHICH ARE NOT THERE IN A, B AND C.