Thursday, March 03, 2011

Interesting ECG (6)

Interesting ECG!
A 40 year-old man who was seen in clinic for history of syncopal attack. He was seen by GP but told to have a "normal heart rhythm". He is worried because he has an uncle who had a sudden death after a syncope. (Enough clues!)

And the diagnosis is?


Related posts:
Interesting ECG (5)
Interesting ECG (4)

10 comments:

changyang1230 said...

Brugada Syndrome with Type 1 ECG.

changyang1230 said...

Are you doing cardiology?

Hann said...

my guess:ischemic heart disease:non-STEMI,focal at anterior wall.

叶子 said...

Brugada!!!!!

Anonymous said...

yan:

Brugada syndrome ^_^

Chong_86 said...

Hi. I'm a final year medical student.
Been following your blog for quite some time. Never attempted any of your quiz though...

Considering the ECG d/d for syncope :

1. ACS
2. Bradycardia
3. Long QT syndrome
4. Brugada syndrome
5. HOCM

Not ACS, not bradycardia definitely.
QTc is normal.

Is it Brugada syndrome?

Just a guess though. Hope you don't mind...

Anonymous said...

brugada syndrome

康宁 said...

is that a Brugada syndrome??

Darren Lee said...

Wow, most of you got it right - great! (Is it because I focus the ECG at only V1-V2? Ha!)

Yes this is Brugada syndrome, but the most specific answer goes to Changyang - it's type 1 ECG changes. If you want to see what are type1-3 changes,you can see at: http://emedicine.medscape.com/article/163751-overview

Just to share some tips on reading ECG of a patient who comes with syncopal attack and how I'd do it:

Most of the ECGs will be seemingly normal (except obvios ischemic changes or AV block or tachyarhythmia) BUT, check for the following:

1. Any signs of voltage-criteria LVH? - may signify a chronic hypertension with paroxysmal AF;

2. Any signs of Old infarct ie Q waves? - Pt probably had a non-sustained VT;

3. Any prolonged Q-T interval? - Could be congenital or acquired LQTS;

4. LVH plus non-specific ST changes? Could it be a HOCM?

5. Lastly, check the V1-V3 carefully - do not miss the Brugada syndrome! ;)

Anonymous said...

Such a systematic way of reviewing ECG. I learnt something again today, thanks!

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