A 58 year old gentleman admitted to Accident and Emergency.

Went to work as normal, while at work became sweaty and could feel his heart racing. He had also had some chest tightness/pain which he rated 2/10

 PMH : NIDDM, MI ‘92, Hypertension 

This is a copy of his ECG on arrival. 

What do you consider his rhythm to be?

What course of action would you consider, or carry out?   

A 45 year old male presents to A&E with collapse, His ECG is as follows.

 What is the rhythm/ Diagnosis on this ECG?     

A 40 yr old gentleman presented at accident and emergency following 40 minutes of palpitations associated with chest pain/tightness. 

He could normally stop the palpitation by drinking/eating ice, but having tried this in vain, he had called for an ambulance. 

What are your findings from this ECG?

Which drug may you consider or give to clarify/rectify the situation?  

One of the drugs most commonly used is Adenosine, this has a very short half life of about 10-15 seconds. It acts predominately on the AV node slowing/blocking impulses to the ventricles. Having given the initial dose of 6mg, he reverted to sinus rhythm, what else can now be seen on the ECG, and would be consistent with someone with episodes of palpitations.?

A 61 year old lady was admitted to A&E following a RTA, she was the driver of the car, she was now complaining of lower leg pain  and central chest pain, worse with inspiration, and increased pain on palpating the chest. She had been driving at 20-30miles /hour hitting another car from behind, causing her own car to spin around, she was flung forward, saved by her seatbelt. No pain initially, felt numb.

PMH: palpitations lasting 10 mins when angry, sometimes associated with chest pain, never had investigations.

No medication

What is your diagnosis of the chest pain?

What are your findings on the ECG? Look closely at rhythm strip under ECG.   

A 71 year old gentleman was admitted as an emergency call, he was appearing to be have short “fits”

He had had four prior to the ambulance arriving, he was sitting in his chair and without warning, became vacant, unresponsive and then had a fit, within 15 seconds he would come round unaware of what had just happened. He was not drowsy/sleepy after the event.

On arrival in A&E he had a further episode while the ECG was being performed. This was the ECG.

What are your findings on the ECG?   

A 68 year old gentleman presented via the ambulance service following breathlessness on exertion. Over the last 3 days he had noted increased shortness of breath while doing simple tasks, like walking up stairs. Over the last 24hrs he had felt light headed when standing, and had a few dizzy spells, while walking around.

He had no previous past medical history, although he did have a family history of ischaemic heart disease.

He took no medication at this time

What are your findings on the ECG?

What is the likely treatment?