EHRA 2021 ECG Contest with correct answers

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CLINICAL CASE:
58 year-old patient, previous smoker, with no other relevant past medical history.
5 months of self-limited episodes of palpitations, without any other symptom.
He is admitted in the E.D. due to a new episode of palpitations, presenting with the following ECG:



Which is your diagnosis?

CLINICAL CASE:
A 85 year-old patient with implanted pacemaker describes fatigue and palpitations.
He presents to your emergency department with the following ECG:



What is your diagnosis?

CLINICAL CASE:
73 year-old male patient
Anamnestic data:

• Previous myocardial infarction treated with angioplasty and stenting
• PM DDD for sick sinus disease

Which is your diagnosis?

CLINICAL CASE:
A 70 year-old patient with history of arterial hypertension and vascular disease describes chest pain and palpitations.
He presents to your emergency department with the following ECG:



What is your diagnosis?

CLINICAL CASE:

• 55 year-old lady
• Background:
  • WPW syndrome with ablation of overt left anterolateral accessory pathway a few years ago
  • HLA B27 positive spondyloarthritis
  • Psoriasis
  • Monoclonal gammopathy of undetermined significance
  • Fibromyalgia

ECG at the GP surgery post ablation

• Referred to heart rhythm clinic for ongoing palpitations and sinus tachycardia – mean HR on a 3-day Holter was 102 bpm
• Medicaton: Flecainide, Methotrexate, Amitriptyline, Meloxicam, Folic acid, Sertraline, Pantoprazole

Which of the patient’s drugs could have caused this change in ECG?

CLINICAL CASE:
79 year-old patient with history of myocardial infarction presents to the ER with wide QRS tachycardia.
Based on the 12 lead ECG which is the most likely diagnosis?

CLINICAL CASE:
47 year-old woman, electrophysiological study for recurrent episodes of palpitations. Normal cardiac echocardiography.



What is your diagnosis ?

CLINICAL CASE:
A 75 year-old patient with history of arterial hypertension and vascular disease describes palpitations.
He presents to your emergency department with the following ECG:



What is your diagnosis ?

CLINICAL CASE :

• 47 year-old Iraqi
• Exertional chest pain and palpitations
• Not exercising regularly
• Non-smoker, non-diabetic
• Slightly overweight (BMI 27 kg/m2)
• Family history: father died suddenly at the age of 52, assumed heart attack, but no autopsy performed

What is the likely diagnosis?

CLINICAL CASE:
67 year-old patient with no known history of heart disease presents to the ER with dizzinness and palpitations.
Based on the 12 lead ECG which is the most likely diagnosis?

Which is your diagnosis?

CLINICAL CASE:
58 year-old patient with ICD (DDD 50-120 bpm) implanted in primary prevention.
Symptom:  pre-syncope



Which is your diagnosis?

CLINICAL CASE:
18 year-old female patient, with family history of sudden cardiac death in a cousin at the age of 20 years old. Past medical history of 3 syncopal episodes, one of them during exercercise. Therefore, an exercise test is performed.
This is the ECG during the test:



Which is the rhythm in this ECG?

CLINICAL CASE:
A 39 year-old patient without cardiovascular disease is resuscitated after cardiac arrest.
He presents to your emergency department with the following ECG:



Which is your diagnosis?

CLINICAL CASE:
81 year-old man hospitalized for elective replacement of DDD pacemaker. Episode of palpitations with no episode recorded by pacemaker. New episode while monitored.



What is your diagnosis ?

CLINICAL CASE:

• 42 year-old female
• Background:
  • Complex Tetralogy of Fallot with pulmonary atresia, right BT shunt and pericardial graft repair of pulmonary atresia at the age of 10
  • Pulmonary hypertension
• Presenting complaint:
  • Six episodes of palpitations over 3 months, lasting between 25 minutes and 2.5 hours at approximately 160bpm
  • She does not feel unwell with this but only feels the palpitations. She had to go to A&E once with the longest episode. Otherwise, she has remained stable and able to perform most of her own activities.

The ECG with tachycardia likely shows:

CLINICAL CASE:
31 year-old patient is referred for ablation due to documented narrow QRS tachycardia.
Tachycardia starts spontaneously as wide QRS tachycardia and spontaneously changes to narrow QRS tachycardia. 12 lead ECG at 50 mm/s recordin speed is shown.
Based on the tracing, which is the most likely diagnosis?

CLINICAL CASE:
48 year-old patient presents to the ER with atrial tachycardia.
Based on the 12 lead ECG which is the most likely origin of atrial tachycardia?

CLINICAL CASE:
27 year-old patient, no history of cardiovascular disease.
Symptom:  syncope



Which is your diagnosis?

CLINICAL CASE:
67 year-old female patient, with past medical history of OSA, COPD and non-filliated stroke one year ago.  She complains of frequent palpitation episodes. This is her ECG:



What catches your attention in this ECG?

CLINICAL CASE:
76 year-old woman, history of myocardial infarction 15 years ago. Preserved LVEF.
Episode of sustained palpitations without hemodynamic compromise.



What is your diagnosis ?

CLINICAL CASE:
29 year-old patient presents to the ER with recurrent palpitations and syncope.
Her medical history so far is unremarkable.
Based on the 12 lead ECG which is the most likely diagnosis?

CLINICAL CASE:
36 year-old patient with no estructural heart disease presents to the ER with palpitations.  Tachycardia is terminate with verapamil iv. 12 lead ECG of tachycardia is shown.
What is the most likely diagnosis?

CLINICAL CASE:
25 year-old patient presents to the ER with palpitations and dizziness. 12 lead ECG of tachycardia is shown.
What is the most likely diagnosis?

Which is your diagnosis?

CLINICAL CASE:
78 year-old patient, ischemic cardiomyopathy.
Symptoms:  palpitations and pre-syncope



Which is your diagnosis?

CLINICAL CASE:
71 year-old male patient, with ischemic dilated cardiomiopathy recently diagnosed, with 3-vessel disease and undergone a bypass surgery.
During and after the surgery, dobutamine infusion is required.
This is the ECG recorded at the ICU:



Which is the rhythm in this ECG?

CLINICAL CASE:
72 year-old female patient with paroxysmal atrial fibrillation and diagnosed of bradicardia-tachycardia syndrome. Dual-chamber pacemaker was implanted for this reason.
The following ECG is recorded at the pacemaker clinic:



What can be seen on this ECG?

CLINICAL CASE:
40 year-old female patient, with past medical history of non-documented palpitations of 5-10 minutes duration. During one of these episodes she goes to the E.R., and an ECG is recorded right at the end of the tachycardia.



Which statement is true about the tachycardia?

CLINICAL CASE:
44 year-old woman, hypertrophic cardiomyopathy. Episodes of palpitations and syncope.



What is your diagnosis ?

CLINICAL CASE:
17 year-old patient presents to the ER with recurrent palpitations and dizziness. His 12 lead ECG is shown. What is the most likely diagnosis?

CLINICAL CASE:
74 year-old female patient with arterial hypertension.
12 months of self-limited episodes of palpitations, no angina, no (pre-)syncopes.
Based on a holter ECG recording, she was diagnosed with atrial fibrillation and submitted for evaluation of coronary angiography.
She presents at clinic with the following ECG*:

Which is your diagnosis?

CLINICAL CASE:
A 16 year-old patient with implanted pacemaker presents to your outpatient clinic with the following ECG:



What is your diagnosis?

CLINICAL CASE:
A 25 year-old lady with Wolff-Parkinson-White syndrome returned to the arrhythmia clinic after 12 years of absence. She had previously undergone unsuccessful ablation of a para-Hisian accessory pathway (AP) as an 11-year-old girl and was observed for mild/moderate left ventricular (LV) impairment. Since then she had been off drugs, she gave birth and recently had experienced palpitations for which she was prescribed flecainide.
Two days later she presented to the emergency department with severe palpitations, then suffered multiple VF arrests thus was given amiodarone. After last VF arrest she was resuscitated into complete heart block (CHB).
Electrophysiological study confirmed conduction via the AP and surprisingly no underlying atrio-ventricular nodal (AVN) activity. Therefore, the conclusion was that she has relied on her AP and when it became blocked by flecainide and then amiodarone, she arrested and went into CHB. Another ablation attempt was only transiently successful in eliminating the AP, so a biventricular defibrillator was implanted and she was discharged on a low dose of angiotensin receptor blocker. At 6-month follow-up no further arrhythmia was observed and the AP was still functional.

A


B


C


D

CLINICAL CASE:
80 year-old man, pacemaker (VVI) for permanent complete AV block without escape rhythm. Asymptomatic. Recording during continous monitoring after elective non-cardiac surgery:



What is your diagnosis?