150 Practice Ecgs

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Transcript of 150 Practice Ecgs

63

150 Practice ECGs

Part I I

As you read the practice ECGs, write the ECG report including rate, rhythm, intervals, axis, and interpretation. If you do not commit yourself on paper, it does not count! Read five to ten ECGs in a row before checking answers. There is a rhythm to this exercise that you should not interrupt. After you have read 150 ECGs, you will be reading them with confidence.

64 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

1

A57

-yea

r-old

man

,pre

oper

ative

ECG

.

Part ii:150PracticeECGs 65

Prac

tice

ECG

2

A78

-yea

r-old

man

,no

hist

ory

prov

ided

.

66 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

3

A54

-yea

r-old

wom

an,a

dmitt

edw

ithc

hole

cyst

itis.

Part ii:150PracticeECGs 67

Prac

tice

ECG

4

A49

-yea

r-old

man

,no

hist

ory

give

n.H

ash

eha

dan

MI?

Whe

n?

68 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

5

A78

-yea

r-old

wom

anw

itha

hist

ory

ofM

Iis

now

inth

eem

erge

ncy

room

with

che

stp

ain.

The

reis

ap

riorE

CGfo

rcom

paris

on.C

any

ou

bes

ure

that

her

pai

nis

due

toM

I?

Part ii:150PracticeECGs 69

Prac

tice

ECG

6

A36

-yea

r-old

man

;life

insu

ranc

eex

amin

atio

n,n

ohi

stor

yof

hea

rtd

iseas

e.

70 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

7

A79

-yea

r-old

man

bro

ught

from

the

nurs

ing

hom

ewi

tha

rapi

dpu

lse.

Part ii:150PracticeECGs 71

Prac

tice

ECG

8

A72

-yea

r-old

wom

anw

ithh

eart

failu

re.W

hati

sth

eca

use?

72 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

9

Ana

ctive

82-

year

-old

wom

anw

ithh

yper

tens

ion.

Sho

uld

wew

orry

abo

utp

ossib

les

ynco

pe?

Part ii:150PracticeECGs 73

Prac

tice

ECG

10

A94

-yea

r-old

wom

anw

ithfa

iling

mem

ory.

74 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

11

A72

-yea

r-old

man

with

alo

ngh

istor

yof

hea

rtd

iseas

e,o

ndi

goxin

.

Part ii:150PracticeECGs 75

Prac

tice

ECG

12

A73

-yea

r-old

wom

anw

ithh

yper

tens

ion,

on

mul

tiple

med

icine

s.Ca

nyo

uid

entif

yon

eof

them

?

76 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

13

A48

-yea

r-old

wom

an;r

outin

eex

am.

Part ii:150PracticeECGs 77

Prac

tice

ECG

14

A67

-yea

r-old

man

;no

hist

ory

prov

ided

.

78 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

15

A43

-yea

r-old

wom

anw

ithh

istor

yof

MIi

sin

the

emer

genc

yro

omw

ithlo

werc

hest

,epi

gast

ricd

iscom

fort

not

qui

teli

keth

ehe

arta

ttack

pa

in.W

ould

you

con

sider

thro

mbo

lytic

ther

apy?

Part ii:150PracticeECGs 79

Prac

tice

ECG

16

A73

-yea

r-old

wom

anw

ithb

lood

pre

ssur

e15

0/75

and

no

hist

ory

ofh

eart

dise

ase.

Sho

uld

she

betr

eate

dfo

riso

lated

sys

tolic

hy

perte

nsio

n?

80 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

17

A46

-yea

r-old

man

;rou

tine

exam

.Nor

mal

ora

bnor

mal

?

Part ii:150PracticeECGs 81

Prac

tice

ECG

18

An8

9-ye

ar-o

ldw

oman

with

dizz

ines

swh

ens

hes

tand

s.

82 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

19

A74

-yea

r-old

man

;no

clini

cald

ata

prov

ided

.

Part ii:150PracticeECGs 83

Prac

tice

ECG

20

A76

-yea

r-old

man

with

hist

ory

ofM

Iand

mild

hea

rtfa

ilure

.Doe

sth

isEC

Gte

llyo

uan

ythi

nga

bout

the

patie

nt’s

coro

nary

ana

tom

y?

84 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

21

A59

-yea

r-old

wom

anw

ithp

erip

hera

lede

ma,

jugu

larv

enou

sdi

sten

sion,

and

alo

uds

ysto

licm

urm

urth

atin

tens

ifies

with

insp

iratio

n.

Part ii:150PracticeECGs 85

Prac

tice

ECG

22

A56

-yea

r-old

wom

ana

dmitt

edth

roug

hth

eem

erge

ncy

room

.Any

gue

ssa

bout

the

natu

reo

fher

acu

teil

lnes

s?

86 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

23

A70

-yea

r-old

man

with

are

mot

ehi

stor

yof

fain

ting

spel

ls.N

owin

the

emer

genc

yro

omw

ithd

yspn

eaa

ndfe

ver.

Part ii:150PracticeECGs 87

Prac

tice

ECG

24

A75

-yea

r-old

man

with

as

ysto

licm

urm

ura

ndh

eart

failu

re.W

hati

sth

edo

min

antv

alvu

larl

esio

n?

88 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

25

An8

0-ye

ar-o

ldm

antr

eate

dwi

thd

iure

tics

and

digo

xin.W

hatl

abw

ork

isne

eded

?

Part ii:150PracticeECGs 89

Prac

tice

ECG

26

A52

-yea

r-old

man

who

had

a2

0-ho

urs

iege

ofi

ndig

estio

na

mon

the

arlie

r.H

eha

sse

vere

fatig

ue.T

hec

ardi

olog

isth

aso

rder

eda

nec

hoca

rdio

gram

.Why

?

90 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

27

A71

-yea

r-old

wom

anin

the

emer

genc

yro

om.A

long

epi

sode

ofc

hest

pai

nwa

sre

lieve

dbe

fore

her

arri

valb

yni

trogl

ycer

ine.

Is

angi

ogra

phy

indi

cate

d?W

hatw

ould

its

how?

Part ii:150PracticeECGs 91

Prac

tice

ECG

28

A79

-yea

r-old

wom

anw

ithm

ildh

yper

tens

ion.

92 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

29

A74

-yea

r-old

wom

anw

itha

hist

ory

ofa

tria

lfib

rillat

ion,

dia

bete

s,hy

perte

nsio

n,o

besit

y,an

dM

I.N

owin

the

emer

genc

yro

omw

ith

pulm

onar

yed

ema.

Part ii:150PracticeECGs 93

Prac

tice

ECG

30

An8

5-ye

ar-o

ldm

anw

ithc

hest

pai

n.T

here

isa

hist

ory

ofM

I.W

hati

shi

spr

ogno

sis?

94 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

31

A61

-yea

r-old

wom

anw

ithp

oorly

con

trolle

dhy

perte

nsio

n.

Part ii:150PracticeECGs 95

Prac

tice

ECG

32

A42

-yea

r-old

man

with

inte

rmitt

entp

alpi

tatio

nss

ince

chi

ldho

od.H

isdo

ctor

isc

once

rned

abo

uth

isco

nduc

tion

abno

rmal

itya

nda

sil

enth

eart

atta

ck.

96 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

33

A38

-yea

r-old

wom

anw

ithp

alpi

tatio

nsa

ndd

izzin

ess.

Part ii:150PracticeECGs 97

Prac

tice

ECG

34

An8

1-ye

ar-o

ldw

oman

inth

eem

erge

ncy

room

with

che

stp

ain.

Wha

tare

the

treat

ing

phys

ician

’sne

xts

teps

?W

ould

you

con

sider

th

rom

boly

ticth

erap

y?

98 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

35

A73

-yea

r-old

man

;no

hist

ory

prov

ided

.

Part ii:150PracticeECGs 99

Prac

tice

ECG

36

A65

-yea

r-old

wom

anw

itha

long

hist

ory

ofb

orde

rline

hyp

erte

nsio

n.W

hatd

oes

this

ECG

tell

you

abou

tcon

trolo

fher

blo

od

pres

sure

?

100 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

37

An8

6-ye

ar-o

ldw

oman

,ann

ualE

CG.

Part ii:150PracticeECGs 101

Prac

tice

ECG

38

An8

2-ye

ar-o

ldm

anw

ithfa

tigue

and

ank

lee

dem

afo

r2w

eeks

.

102 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

39

A62

-yea

r-old

man

inth

eem

erge

ncy

room

ofa

com

mun

ityh

ospi

tal.

Befo

rea

rriva

l,he

had

che

stp

ain

for2

hou

rs,t

hen

relie

f.Pa

inh

as

now

recu

rred.

Isit

too

late

forr

eper

fusio

nth

erap

y?

Part ii:150PracticeECGs 103

Prac

tice

ECG

40

Sam

epa

tient

(N

o.3

9),2

hou

rsa

ftert

reat

men

twith

tiss

uep

lasm

inog

ena

ctiva

tor.

104 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

41

A26

-yea

r-old

with

no

sym

ptom

s.W

hich

dia

gnos

ticte

stis

nee

ded?

Part ii:150PracticeECGs 105

Prac

tice

ECG

42

A32

-yea

r-old

man

with

fixe

dsp

littin

gof

the

seco

ndh

eart

sou

nda

nda

loud

mur

mur

.Wha

tis

the

illnes

s?

106 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

43

A40

-yea

r-old

man

inth

eem

erge

ncy

room

follo

wing

an

episo

deo

fsyn

cope

.He

has

been

trea

ted

with

ery

thro

myc

ina

nda

ntih

istam

ines

fo

rare

spira

tory

illn

ess.

Part ii:150PracticeECGs 107

Prac

tice

ECG

44

Tele

met

ryre

cord

ing

the

sam

epa

tient

(N

o.4

3)4

hou

rsla

ter.

Dur

ing

the

arrh

ythm

ia,h

elo

stc

onsc

ious

ness

.

108 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

45

Rhyt

hms

trip

sfro

ma

52-

year

-old

wom

anw

ithc

ardi

omyo

path

yan

dep

isodi

cdi

zzin

ess.

Dur

ing

the

third

trac

ing,

she

lost

con

scio

usne

ss.

Part ii:150PracticeECGs 109

Prac

tice

ECG

46

An8

7-ye

ar-o

ldw

oman

with

ah

istor

yof

dizz

ysp

ells.

110 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

47

A45

-yea

r-old

man

afte

ra4

5-m

inut

eep

isode

ofc

hest

pai

n.

Part ii:150PracticeECGs 111

Prac

tice

ECG

48

A68

-yea

r-old

wom

ana

fteri

ndig

estio

nof

9h

ours

dur

atio

n.W

hatt

reat

men

tis

indi

cate

d?

112 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

49

A76

-yea

r-old

wom

anw

ithd

iabe

tes;

year

lye

xam

inat

ion.

Part ii:150PracticeECGs 113

Prac

tice

ECG

50

A75

-yea

r-old

man

who

take

she

artp

ills.

114 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

51

An8

2-ye

ar-o

ldw

oman

with

mild

hea

rtfa

ilure

.

Part ii:150PracticeECGs 115

Prac

tice

ECG

52

A40

-yea

r-old

man

with

syn

cope

.

116 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

53

A69

-yea

r-old

man

with

ah

istor

yof

hea

rtfa

ilure

.

Part ii:150PracticeECGs 117

Prac

tice

ECG

54

A70

-yea

r-old

wom

anw

itha

rem

ote

hist

ory

ofM

Iand

ah

istor

yof

atr

ialf

ibril

latio

n.

118 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

55

A60

-yea

r-old

man

;no

clini

cald

ata

prov

ided

.

Part ii:150PracticeECGs 119

Prac

tice

ECG

56

An8

1-ye

ar-o

ldw

oman

ine

xcel

lent

hea

lth.

120 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

57

A72

-yea

r-old

man

with

ah

istor

yof

arrh

ythm

ias.

Part ii:150PracticeECGs 121

Prac

tice

ECG

58

A31

-yea

r-old

wom

ans

entt

oa

clini

cbe

caus

ehe

rECG

sho

wed

ahe

arta

ttack

.She

had

no

hist

ory

ofM

I.O

nex

amth

ere

was

ahe

art

mur

mur

.

122 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

59

A64

-yea

r-old

wom

anw

ithe

mph

ysem

aan

dan

klee

dem

a.

Part ii:150PracticeECGs 123

Prac

tice

ECG

60

A69

-yea

r-old

man

with

eas

yfa

tigue

and

exe

rtio

nald

yspn

ea.

124 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

61

A75

-yea

r-old

man

with

pul

mon

ary

edem

a.

Part ii:150PracticeECGs 125

Prac

tice

ECG

62

An8

3-ye

ar-o

ldm

anw

itha

long

hist

ory

ofir

regu

larp

ulse

.He

ison

dig

oxin

.Doe

she

nee

dad

ditio

nald

rug

ther

apy?

126 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

63

A59

-yea

r-old

man

inth

eem

erge

ncy

room

.

Part ii:150PracticeECGs 127

Prac

tice

ECG

64

An8

2-ye

ar-o

ldm

ano

ndi

goxin

sen

tfro

mth

enu

rsin

gho

me

with

con

fusio

nan

dbl

urre

dvis

ion.

128 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

65

A66

-yea

r-old

man

with

ah

istor

yof

vag

ue,n

onsp

ecifi

cch

estp

ain

and

apo

sitive

stre

sste

st.

Part ii:150PracticeECGs 129

Prac

tice

ECG

66

A26

-yea

r-old

wom

anw

ithp

alpi

tatio

ns.H

erE

CGw

asn

orm

alth

eda

yaf

tert

his

tracin

gwa

sob

tain

ed.

130 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

67

An8

6-ye

ar-o

ldm

anw

ithd

izzy

spel

lsfo

r1w

eek,

onn

om

edici

ne.W

hats

houl

dhi

sdo

ctor

do?

Part ii:150PracticeECGs 131

Prac

tice

ECG

68

An8

5-ye

ar-o

ldw

oman

with

mild

hea

rtfa

ilure

,on

digo

xin.

132 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

69

A70

-yea

r-old

wom

anw

itha

nkle

ede

ma

ontw

odi

uret

icsa

ndp

otas

sium

sup

plem

ents

.

Part ii:150PracticeECGs 133

Prac

tice

ECG

70

A77

-yea

r-old

man

inth

eem

erge

ncy

room

with

pou

ndin

gin

his

ches

t.

134 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

71

An8

1-ye

ar-o

ldw

oman

with

che

stp

ain.

Part ii:150PracticeECGs 135

Prac

tice

ECG

72

A78

-yea

r-old

wom

an,p

osto

pera

tive

ECG

.The

pre

oper

ative

trac

ing

show

edm

ildin

trave

ntric

ular

con

duct

ion

defe

ct.

136 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

73

A54

-yea

r-old

wom

anw

itha

hist

ory

ofp

arox

ysm

ala

tria

lfib

rillat

ion.

Part ii:150PracticeECGs 137

Prac

tice

ECG

74

A72

-yea

r-old

wom

anw

ithc

hest

pai

nof

2h

ours

dur

atio

n.W

hati

sth

eco

rrect

trea

tmen

t?

138 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

75

An8

0-ye

ar-o

ldw

oman

with

pre

vious

MI.

Wha

tis

the

orig

ino

fthe

ect

opic

beat

s?

Part ii:150PracticeECGs 139

Prac

tice

ECG

76

A64

-yea

r-old

wom

anw

ithc

hron

icco

ugh,

dys

pnea

,and

ank

lee

dem

a.S

hes

tills

mok

estw

opa

cks

ofc

igar

ette

sa

day.

140 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

77

A67

-yea

r-old

wom

antr

ansf

erre

dbe

caus

eof

a1

-hou

repi

sode

ofc

hest

pai

non

the

prev

ious

day

.

Part ii:150PracticeECGs 141

Prac

tice

ECG

78

A39

-yea

r-old

farm

erw

hose

wife

dro

veh

imto

the

loca

lem

erge

ncy

room

with

che

stp

ain

that

beg

an3

0m

inut

ese

arlie

r.H

eis

70m

iles

from

the

regi

onal

car

diac

cen

ter.

Wha

tis

the

appr

opria

tetr

eatm

ent?

142 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

79

Sam

epa

tient

(N

o.7

8),a

bout

1h

ourl

ater

.Che

stp

ain

has

reso

lved.

Wha

tis

the

treat

men

tnow

?

Part ii:150PracticeECGs 143

Prac

tice

ECG

80

Sam

epa

tient

(N

o.7

8),a

fter2

day

sof

hep

arin

ther

apy

atth

elo

calh

ospi

tal.

He

has

deve

lope

dm

ore

ches

tpai

n,b

utn

otq

uite

like

wha

the

had

att

heti

me

ofa

dmiss

ion.

144 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

81

A46

-yea

r-old

man

with

che

stp

ain

of3

hou

rsd

urat

ion.

Wha

ttre

atm

entw

ould

be

appr

opria

te?

Part ii:150PracticeECGs 145

Prac

tice

ECG

82

A60

-yea

r-old

wom

anin

goo

dhe

alth

;rou

tine

exam

.

146 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

83

A75

-yea

r-old

wom

antr

ansf

erre

dfro

ma

nur

sing

hom

ewi

thd

yspn

eaa

ndp

leur

isy.

Part ii:150PracticeECGs 147

Prac

tice

ECG

84

A74

-yea

r-old

man

inth

eem

erge

ncy

room

with

che

stp

ain

that

beg

an3

0m

inut

ese

arlie

r.Is

this

angi

nao

rMI?

Isth

eisc

hem

iaa

nte-

rioro

rint

erio

r?

148 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

85

A56

-yea

r-old

man

with

no

card

iac

hist

ory;

he

want

sto

sta

rta

jogg

ing

prog

ram

.

Part ii:150PracticeECGs 149

Prac

tice

ECG

86

A57

-yea

r-old

man

trea

ted

forh

yper

tens

ion.

Isth

ere

evid

ence

ofh

yper

tens

iveh

eart

dise

ase?

150 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

87

An8

2-ye

ar-o

ldm

anw

ithp

alpi

tatio

nsa

ndd

izzin

ess.

Part ii:150PracticeECGs 151

Prac

tice

ECG

88

An8

0-ye

ar-o

ldw

oman

with

ah

istor

yof

MIa

nda

pac

emak

er;r

outin

ecli

nic

visit.

152 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

89

A59

-yea

r-old

wom

anw

ithin

term

itten

tind

iges

tion

of2

wee

ksd

urat

ion.

Part ii:150PracticeECGs 153

Prac

tice

ECG

90

A48

-yea

r-old

man

with

ah

istor

yof

infe

riorM

I.H

ash

eha

da

seco

ndM

I?

154 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

91

A50

-yea

r-old

with

ah

istor

yof

MI.

Hav

eth

ere

been

mul

tiple

infa

rctio

ns?

Part ii:150PracticeECGs 155

Prac

tice

ECG

92

A56

-yea

r-old

man

;pre

oper

ative

ECG

.

156 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

93

A65

-yea

r-old

wom

anw

iths

epsis

.

Part ii:150PracticeECGs 157

Prac

tice

ECG

94

A52

-yea

r-old

man

sen

tto

card

iolo

gyc

linic

beca

use

ofa

nab

norm

alE

CG.H

eha

shy

perte

nsio

nbu

tno

hist

ory

ofc

hest

pai

n.

158 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

95

A63

-yea

r-old

man

;ann

uale

xam

.

Part ii:150PracticeECGs 159

Prac

tice

ECG

96

A71

-yea

r-old

man

with

che

stp

ain

for3

hou

rs.

160 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

97

A58

-yea

r-old

man

;no

clini

cald

ata

prov

ided

.

Part ii:150PracticeECGs 161

Prac

tice

ECG

98

An8

1-ye

ar-o

ldw

oman

;no

clini

cald

ata

prov

ided

.

162 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

99

A73

-yea

r-old

man

ing

ood

heal

th.

Part ii:150PracticeECGs 163

Prac

tice

ECG

100

A

63-y

ear-o

ldm

an;r

outin

eex

amin

atio

n.

164 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

101

A

46-y

ear-o

ldm

an;i

nsur

ance

phy

sical

.

Part ii:150PracticeECGs 165

Prac

tice

ECG

102

A

patie

ntw

itha

nirr

egul

arp

ulse

.

166 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

103

A

68-y

ear-o

ldw

oman

with

acu

tein

ferio

rMI.

Doe

ssh

ene

eda

tem

pora

ryp

acem

aker

?

Part ii:150PracticeECGs 167

Prac

tice

ECG

104

A

55-y

ear-o

ldm

anw

ithp

alpi

tatio

nsa

nda

hist

ory

ofM

I.

168 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

105

A

75-y

ear-o

ldw

oman

with

obs

truc

tive

lung

dise

ase

and

ankle

ede

ma.

Part ii:150PracticeECGs 169

Prac

tice

ECG

106

A

54-y

ear-o

ldm

anw

ithn

ohi

stor

yof

hea

rtd

iseas

e.H

ewe

ighs

275

pou

nds.

170 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

107

A

53-y

ear-o

ldm

anh

adc

hest

pai

nof

90

min

utes

dur

atio

nea

rlier

inth

eda

y.Sh

ould

we

cons

ider

thro

mbo

lytic

ther

apy?

Part ii:150PracticeECGs 171

Prac

tice

ECG

108

A

70-y

ear-o

ldw

oman

with

che

stp

ain

of5

hou

rsd

urat

ion.

Sho

uld

she

have

thro

mbo

lytic

ther

apy?

172 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

109

An

86-

year

-old

wom

ano

ndi

goxin

.

Part ii:150PracticeECGs 173

Prac

tice

ECG

110

A

70-y

ear-o

ldw

oman

with

che

stp

ain

of2

hou

rsd

urat

ion.

The

reis

no

old

ECG

forc

ompa

rison

.Sho

uld

she

have

thro

mbo

lytic

th

erap

y?

174 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

111

Sa

me

patie

nt(

No.

110

),3

hour

slat

er.

Part ii:150PracticeECGs 175

Prac

tice

ECG

112

A

46-y

ear-o

ldm

anw

ithp

oorly

con

trolle

dhy

perte

nsio

nan

dre

nalf

ailu

re.

176 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

113

A

43-y

ear-o

ldm

anre

ferre

dfo

reva

luat

ion

ofh

eart

failu

re.

Part ii:150PracticeECGs 177

Prac

tice

ECG

114

A

52-y

ear-o

ldw

oman

with

pal

pita

tions

.The

reis

no

othe

rhist

ory

ofh

eart

dise

ase.

Thi

sis

hers

econ

dep

isode

.Wha

twor

kup

isne

eded

?

178 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

115

A

78-y

ear-o

ldw

oman

with

che

sth

eavin

ess

of5

hou

rsd

urat

ion

and

dysp

nea.

Wou

ldth

rom

boly

ticth

erap

yin

fluen

ces

urviv

al?

Part ii:150PracticeECGs 179

Prac

tice

ECG

116

A

41-y

ear-o

ldm

ano

nth

eps

ychi

atric

uni

t.

180 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

117

A

19-y

ear-o

ldw

oman

with

cya

nosis

,let

harg

y,an

da

hist

ory

ofh

eart

mur

mur

.Wha

toth

erp

hysic

alfi

ndin

gsw

ould

you

exp

ect?

Part ii:150PracticeECGs 181

Prac

tice

ECG

118

A

73-y

ear-o

ldm

anw

itha

sys

tolic

mur

mur

that

radi

ates

toh

isne

ck.

182 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

119

A

28-y

ear-o

ldm

anw

ithlo

ngfi

nger

s,hi

gha

rche

dpa

late,

and

ad

iasto

licm

urm

ur.

Part ii:150PracticeECGs 183

Prac

tice

ECG

120

A

51-y

ear-o

ldm

anw

itha

hist

ory

ofM

I.

184 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

121

A

68-y

ear-o

ldm

anro

used

from

sle

epb

ych

estp

ain

6ho

urs

earli

er;a

ntac

ids

did

noth

elp.

Alth

ough

the

pain

iss

ever

e,is

itto

olat

efo

rre

perfu

sion

ther

apy?

Part ii:150PracticeECGs 185

Prac

tice

ECG

122

A

67-y

ear-o

ldw

oman

with

ah

istor

yof

hyp

erte

nsio

n.Is

ther

ehy

perte

nsive

hea

rtd

iseas

e?

186 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

123

A

56-y

ear-o

ldm

anre

ferre

dbe

caus

eof

sile

ntM

I.

Part ii:150PracticeECGs 187

Prac

tice

ECG

124

An

82-

year

-old

wom

anin

goo

dhe

alth

unt

ilth

eon

seto

fche

stp

ain

2ho

urs

earli

er.S

houl

dsh

eha

veth

rom

boly

ticth

erap

y?

188 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

125

A

51-y

ear-o

ldw

oman

with

hyp

erte

nsio

nan

dpa

roxy

smal

atr

ialf

ibril

latio

n.W

hich

med

icine

sis

she

takin

g?

Part ii:150PracticeECGs 189

Prac

tice

ECG

126

A

76-y

ear-o

ldm

anw

hois

ap

atie

ntin

the

pulm

onar

yun

it.W

hich

med

icine

sco

uld

beu

sed

toc

ontro

lthe

hea

rtra

te?

190 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

127

A

35-y

ear-o

ldm

ano

nth

eda

yaf

terc

oron

ary

bypa

sss

urge

ry.

Part ii:150PracticeECGs 191

Prac

tice

ECG

128

A

72-y

ear-o

ldw

oman

with

vag

ue,n

onsp

ecifi

cch

estp

ain

unre

spon

sive

toa

ntac

ids.

192 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

129

A

77-y

ear-o

ldm

anw

itha

hist

ory

ofM

Iand

con

gest

iveh

eart

failu

re.

Part ii:150PracticeECGs 193

Prac

tice

ECG

130

A

23-y

ear-o

ldw

oman

with

irre

gula

rpul

se.M

ustw

ebe

con

cern

edb

yth

isar

rhyt

hmia

?

194 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

131

A

73-y

ear-o

ldm

anw

ithc

hest

pai

n.S

houl

dhe

hav

eth

rom

boly

ticth

erap

y?W

hato

ther

test

swo

uld

you

reco

mm

end?

Part ii:150PracticeECGs 195

Prac

tice

ECG

132

A

52-y

ear-o

ldm

anw

ithh

istor

yof

MI.

Do

the

ECG

find

ings

indi

cate

pro

gnos

is?

196 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

133

A

55-y

ear-o

ldw

oman

with

con

fusio

n,le

thar

gy,a

ndd

ifficu

ltys

peak

ing.

Part ii:150PracticeECGs 197

Prac

tice

ECG

134

An

83-

year

-old

wom

anw

ithh

eart

failu

re.

198 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

135

A

54-y

ear-o

ldm

anw

ith2

hou

rso

fche

stp

ain

heth

ough

twas

ple

urisy

.He

has

had

the

flu.

Part ii:150PracticeECGs 199

Prac

tice

ECG

136

A

78-y

ear-o

ldm

anin

the

emer

genc

yro

omw

ithp

ulm

onar

yed

ema

and

ches

tpai

n(d

urin

gth

isEC

Gre

cord

ing)

.

200 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

137

A

54-y

ear-o

ldw

oman

with

alo

ngh

istor

yof

pal

pita

tions

;yea

rlye

xam

inat

ion.

Part ii:150PracticeECGs 201

Prac

tice

ECG

138

A

48-y

ear-o

ldm

ana

dmitt

ed2

day

sea

rlier

with

che

stp

ain

that

reso

lved

14h

ours

late

r.

202 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

139

A

66-y

ear-o

ldm

anw

itha

hist

ory

ofp

alpi

tatio

ns.H

ewa

sad

mitt

edw

ithp

neum

onia

and

feve

r.

Part ii:150PracticeECGs 203

Prac

tice

ECG

140

Sa

me

patie

nt(

No.

139

);th

epn

eum

onia

isb

eing

trea

ted

and

heis

afe

brile

.

204 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

141

A

53-y

ear-o

ldw

oman

with

ah

istor

yof

hyp

erte

nsio

nan

dsm

okin

g.

Part ii:150PracticeECGs 205

Prac

tice

ECG

142

A

72-y

ear-o

ldw

oman

with

feve

rand

exa

cerb

atio

nof

chr

onic

bron

chiti

s.

206 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

143

A

72-y

ear-o

ldm

anw

ithc

hest

pai

nof

6h

ours

dur

atio

n.Is

ther

ean

terio

risc

hem

ia?

Part ii:150PracticeECGs 207

Prac

tice

ECG

144

A

59-y

ear-o

ldm

anin

the

emer

genc

yro

omw

ithra

les,

ches

tpai

n,a

nda

sys

tolic

blo

odp

ress

ure

of8

0m

mH

g.W

hati

sth

eap

prop

riate

tre

atm

ent?

208 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

145

A

59-y

ear-o

ldm

anw

hoh

adc

oron

ary

bypa

sss

urge

ry4

wee

kse

arlie

r.Fo

rthe

last

wee

khe

has

had

ple

urisy

,fev

era

ndm

yalg

ia.H

isfa

m-

ilyd

octo

rbeg

antr

eatm

entf

orp

neum

onia

,but

he

has

notr

espo

nded

toa

ntib

iotic

s.

Part ii:150PracticeECGs 209

Prac

tice

ECG

146

A

69-y

ear-o

ldw

oman

inth

eem

erge

ncy

room

with

che

stp

ain.

210 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

147

A

76-y

ear-o

ldw

oman

with

au

rinar

ytra

ctin

fect

ion

and

poss

ible

sep

sis.

Part ii:150PracticeECGs 211

Prac

tice

ECG

148

A

70-y

ear-o

ldm

anw

ithc

hest

pai

n.

212 150PracticeECGs:InterpretationandReview

Prac

tice

ECG

149

An

82-

year

-old

wom

anw

ithd

izzin

ess

and

ches

tpai

n.

Part ii:150PracticeECGs 213

Prac

tice

ECG

150

A

24-y

ear-o

ldE

CGte

chni

cian.