中国区国际心电图培训课程之典型病例

SELFASSESSMENT Case 1. a. Atrial septal defect b. Partial right bundle branch block c. Brugadas syndrome d. False image of right bundle branch block A young, asthenic man, with no apparent heart disease. The figure shows an ECG recording in V1, V2 and V3 leads located in 2nd (A), 3rd (B) and 4th (C) intercostal space. What is the correct diagnosis? Case 2 A. Acute pericarditis B. Early repolarization in a subject with a horizontal heart with levorotation C. Acute phase of a myocardial infarction D. Superoanterior hemiblock A 27year-old man, with no apparent heart disease. What is the correct diagnosis? Case 3 An 18-year-old lean man, asymptomatic, with no heart disease. What is the correct diagnosis? A. Left ventricular enlargemen B. Normal ECG variant. Vertical heart with apparent levorotation C. Left ventricular enlargement D. Normal ECG. Heart with no rotation Case 4 A 28-year-old very lean man, with slight pectus excavatum, but with no apparent heart disease. What is the correct diagnosis? A. Right ventricular enlargement B. Heart with the apex backward C. Superoanterior hemiblock D. Vertical heart Case 5 A 35-year-old man with no apparent heart disease. What is the correct diagnosis? A. Heart with no apparent rotation B. Vertical heart C. Horizontal heart D. Indeterminate electrical axis Case 6 A 6-year-old child with no apparent heart disease. What is the correct diagnosis? A. Normal ECG B. Right ventricular enlargement C. Left ventricular enlargement D. Pericarditis Case 7 These are leads V1 and V2 of a 60-year-old woman with a heart disease. Which is the correct diagnosis? A.Lateral myocardial infarction B.Significant right enlargement C.Complete right bundle branch block D.Type-II WolffParkinsonWhite Syndrome Case 8 This is a 45-year-old patient suffering from a heart disease, with the diagnosis having been made 30 years ago. Which is the correct diagnosis? A.Significant left ventricular and atrial enlargement B.Complete left bundle branch block C.Complete superoanterior hemiblock D.Acute septal infarction Case 9 This is a 65-year-old patient. The history-taking presents antecedents of chronic obstructive pulmonary disease dating back more than 20 years (recently with an acute crisis). Which is the correct diagnosis? A.Right ventricular and atrial enlargement B.Complete right bundle branch block C.Acute coronary syndrome with a negative T wave from V1 to V3 D.Normal variant (vertically-orientated heart) with no associated disease Case 10 This is a noncyanotic newborn with a systolic 5/6 murmur in the second left intercostal space. Which is the correct diagnosis? A.Ventricular septal defect B.Significant pulmonary stenosis C.Atrial septal defect D.Mitral regurgitation Case 11 This is a 55-year-old patient with a known heart disease evolving during more than 30 years. Which is the correct diagnosis? (ECG is shown at half voltage) A.Wolff-Parkinson-White Syndrome B.Complete left bundle branch block C.Significant left ventricular enlargement D.Mild left ventricular enlargement Case 12 This is a 30-year-old patient with a rsR morphology in V1. Which is the correct diagnosis? A.Right ventricular enlargement + partial right bundle branch block B.Right bundle branch block of new onset due to a pulmonary embolism C.Isolated complete right bundle branch block D.Brugadas syndrome Case 13 This is a 45-year-old patient with signs of heart failure and poor ventricular function. Which is the correct diagnosis? A.Partial left bundle branch block B.Complete left bundle branch block in a patient with a dilated cardiomyopathy, probably of the ischemic type. C.Isolated complete left bundle branch block D.Type-I WolffParkinsonWhite Syndrome Case 14 This is a 34-year-old patient with frequent paroxysmal arrhythmia crises. Which is the correct diagnosis? A.Lateral myocardial infarction B.Type-III WolffParkinsonWhite Syndrome C.Right ventricular enlargement D.Complete right bundle branch block Case 15 This is a 46-year-old patient with frequent paroxysmal arrhythmia crises (see the recording at the bottom). Which is the correct diagnosis? A.Lateral myocardial infarction + ventricular tachycardia B.Type IV WolffParkinson-White syndrome + paroxysmal atrial fibrillation C.Right ventricular enlargement D. Right bundle branch block + right ventricula enlargement Case 16 This is a patient who suffered a myocardial infarction two days ago, and received early therapy with fibrinolytic agents. The ST-segment elevation in the acute phase was located in leads II, III and VF, with a more significant ST elevation in lead III than in II; ST-segment depression is found in lead I and ST-segment elevation is observed in the extreme right precordial leads and in V1-V2. Which is the artery involved in this infarction? A.Distal right coronary artery B.Dominant right coronary artery proximal to the right ventricle branch C.Proximal left circumflex coronary artery D.Distal left circumflex coronary artery Case 17 This is a 55-year-old patient with an acute coronary syndrome involving the anteroseptal wall (ST-segment elevation in leads V1 through V5 and in VR and VL) and an evident ST-segment depression that is apparent in leads II, III, VF and V6. Give your comments, and your opinion, regarding the characteristics of the occluded artery and the localization of the stenotic lesion. A.Proximal occlusion of the left anterior descending coronary artery before the take-off of the first diagonal and first septal branches B.Occlusion of the left anterior descending coronary artery proximal to the take-off of the first diagonal branch, but distal to the take-off of the first septal branch C.Occlusion of the left anterior descending coronary artery distal to the take-off of the first diagonal branch and the first septal branch D.Occlusion of the first diagonal branch Case 18 This is a 62-year-old patient with an acute myocardial infarction that occurred one month ago. Which is the infarction location? A.Impossible to locate B.Isolated inferior C.Isolated lateral D.Inferolateral Case 19 This is an asymptomatic 35-year-old patient, with no abnormal findings on physical examination. In your opinion, which is the diagnosis? A.Severe aortic stenosis B.Hypertrophic cardiomyopathy C.Athlete D.Ischemic heart disease Case 20 This is a 65-year-old patient complaining of palpitations. No chest pain is referred. Which is the correct diagnosis? A.Normal variant B.Chronic lateral infarction C.Hypertrophic cardiomyopathy D.Heart displaced by a large left pleural effusion Case 21 This is an ECG from 57-year-old male patient who has presented several rest angina crises during the last hours, lasting over 30 minutes (acute coronary syndrome). This ECG recording is frequently seen in acute coronary syndromes presenting with involvement of one of the following coronary arteries: A.Proximal right coronary artery B.Left main or equivalent C.Two-vessel disease D.Proximal left anterior descending coronary artery Case 22 This is from a 34-year-old patient, athlete, asymptomatic, presenting during a check-up with tall QRS complexes in V5 - 6 with a positive T wave, rSr in V1 and first-degree atrioventricular block in the ECG. Which is the correct diagnosis? A.Normal variant in an athlete. The nocturnal and during exercise response of the first degree atrioventricular block should be assessed. B.The V1 morphology advises to rule out Brugadas pattern. C.Biventricular enlargement. D.Right bundle branch block, supported by the presence of a rsr morphology in V1. Case 23 R wave in I and II leads, and RS waves in III lead, corresponds to an QRS of ? A. +90 B. +30 C.