High-Yield Image Based Question on ECG

ECG Shows Ventricular Bigeminy 

Normal sinus rhythm (NSR) followed by T wave which is followed by Premature ventricle ectopic/contraction · i.e., Alternate NSR-PVC sequence (Ventricular bigeminy) is seen in the ECG tracing. (NSR – Normal sinus rhythm = Every P wave followed by QRS complex) · Premature ventricle ectopic/contraction (PVC) – characterized by Broad QRS complex · Ventricular Bigeminy is the commonest arrhythmia of Digoxin toxicity · DOC for Ventricular Bigeminy is IV Lignocaine.

Diagnosis: LVH 

Systolic murmurs are heard in valvular lesions of obstructive nature · The patient is having either Aortic stenosis or Pulmonary Stenosis. · As parent is old aged, it is likely to be AORTIC stenosis which is resulting in LVH.

Also Read: Aortic Aneurysm- Thoracic And Abdominal Aortic Aneurysm

Voltage Criteria for LVH

 Precordial leads: SV1+RV5 or RV6 >35mm · Limb leads: RaVL + SV3 >20mm in women / >28mm in men · Not very accurate in the obese and athletes.

QRS complex has a slurred upstroke, which is a suggestive of WPW syndrome

 WPW syndrome/pre-excitation syndrome-T. Wide QRS complex -T ⓃQRS complex is 80-100 msec i.e. 2 small squares · Rx: For pre-excitation syndrome is implantable cardioverter defibrillator. Because the parent has tendency for tachyarrhythmias · Pacemaker is the treatment of choice for Bradyarrhythmias · Delta waves syndrome-T · WPW syndrome / pre-excitation syndrome patient has tachyarrhythmias so pacemaker is not the treatment of choice in this condition.  Pre-excitation syndrome can be  Wolff Parkinson White syndrome , Lown Ganong Levine syndrome.

Both conditions flecainide/ procainamide can be used

• Flecainide acts on bundle of kent.
• Definitive Rx is Radio frequency ablation to destroy accessory tracts

Also Read: Polymorphic Ventricular Tachycardia, Repolarization Abnormality and Genetic Arrhythmia Syndrome 

Diagnosis: Paroxysmal supraventricular tachycardia (PSVT) 

ECG findings  Narrow QRS complex, HR: 200/min , P-Wave Θ, ST segment depression · Therefore, the diagnosis in this patient is PSVT. · Drug used in PSVT is Adenosine.

Mobitz II Heart Block

ECG shows · P Wave followed by broad · QRS complex followed by ST Segment depression followed by P Wave and missed QRS complex and again P Wave. · PR interval before and after missed beat is equal suggesting of Mobitz II heart block.

3 degree Heart Block

Cannon A waves are seen in 2 cases:

1. Ventricular Tachycardia rd

2. 3 degree heart block

• R-R [ventricular rate] intervals and P-P [atrial rate] intervals are not equal
• Unequal R-R and P-P intervals are seen in 3 degree heart block. 

ECG shows Mobitz II heart block 

Brady arrhythmia develops after MI is Mobitz II heart block · PR interval after and before missed beat is equal

Hope you found this blog helpful for your NEET SS Medicine Cardiovascular Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.