A walk through Syncope

This week take a chance to walk step by step through an initially complex appearing EKG.  Dr. Mattu shows how a step by step approach, stopping at each abnormality found to analyze the differential.  A reminder of his systematic approach: Click the Read More link to see some of the diferentials discussed this week.

1. Rate and rhythm
2. Axis
3. Intervals
4. Enlargement
5. Ischemia/infarction

Copa Cardiogram #58

DDx:
Leftward Axis

• LBBB
• Pacer
• WPW
• Inferior MI (from Q waves)
• LAFB
• LVH
• Hyper K
• Normal Variant

DDx:
Wide QRS

• BBB (LBBB, RBBB)
• Pacer
• WPW
• Ventricular ectopy
• Metabolic (acidosis, hyperK)
• Sodium channel blockers
• Non Specific Interventricular Conduction Delay (eg LVH)

DDx: 
T Wave Inversions

• CAD (acute or chronic)
• Abnormal repolarization
  • LBBB, pacers, RBBB, LVH, RVH
• WPW
• Pulmonary disease
  • PE, PHTN (acute or chronic), hyperventilation
• CNS events
• Hyperkalemia