ECG ANALYSIS AND DIAGNOSIS
by [Name]
Healthcare and Medicine
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Scenario 4)
A 29-year-old female consults her physician after experiences intermittent periods of palpitations accompanied by dizziness, shortness of breath and fatigue.
Rate: varies
Rhythm: irregular
P wave: Variable (None, antegrade or retrograde)
P: QRS ratio: None; or 1:1 if antegrade or retrograde
PR interval: None, short, or retrograde (If present does not present atrial stimulation of the ventricles)
QRS width: Normal
T wave: Present
ST-segment: Normal
QT intervals: Normal
Grouping: None
Dropped beats: Yes
Electrical axis: Normal, right axis or left axis deviation
Diagnose the rhythm: Atrial fibrillation
Justification for the diagnosis: the numerous pacemaker cells in the atria are firing chaotically in a totally haphazard manner. The effect is the absence of a descendible P wave, irregularly inverted QRS complexes. The random intervals are attributed to the ventricles lacking a single site of pacing.
Scenario 5)
A 73-year-old male is taken to hospital after experiencing episodes of syncope, dizziness and confusion.
Rate: 300 / 5 = 60
Rhythm: Regular
P wave: Present
P: QRS ratio: 1:1
PR interval: Normal slightly prolonged
QRS width: Normal slightly prolonged
T wave: Present
ST-segment: Normal
QT intervals: Normal
Grouping: None
Dropped beats: None
Electrical axis: normal, right axis or left axis deviation
Diagnose the rhythm: Sinus Bradycardia
Justification for the diagnosis: The slower rhythm origin may be at the SA node in the atrial pacemaker. It may be as a result of the vagal stimulation causing nodal slowing. It may also be attributed to medicine such as beta-blockers.
Scenario 6)
A 42-year-old female is consulting her physician after experiencing palpitations and a rapid pulse rate.
Rate: 300/ 3 = 100
Rhythm: Regular
P wave: Present
P: QRS ratio: 1:1
PR interval: Normal
QRS width: Normal
T wave:
ST-segment:
QT intervals:
Grouping: None
Dropped beats: None
Electrical axis: normal, right axis or left axis deviation
Diagnose the rhythm: Sinus tachycardia
Justification for the diagnosis: The condition may result from medication or by conditions necessitating an increased cardiac output, for instance, haemorrhage, acidosis, hypoxemia and exercise.
Scenario 7)
A 58-year-old female has reported feeling short of breath and a racing heart. Her physician identifies that she also presents with hypotension.
Rate: 7 x 10 =70;
Rhythm: Irregular
P wave: Different morphologies
P: QRS ratio: 1:1
PR interval: Variable depending on the focus
QRS width: Normal
T wave: Different morphologies
ST-segment: Normal
QT intervals: Normal
Grouping: None
Dropped beats: None
Electrical axis: normal, right axis or left axis deviation
Diagnose the rhythm: Wandering Atrial Pacemaker
Justification for the diagnosis: This is an irregularly irregular rhythm formed as a result of multiple atrial pacemakers firing at its own pace. This causes the different attributes of the p waves having their own intrinsic PR interval.
Scenario 8)
A 55-year-old male has reported tightness in his chest during light physical exertion. He has a history of hypertension and a family history of heart disease (his father died of a heart attack).
Rate: 7 x 10 = 70;
Rhythm: irregularly irregular
P wave: None; chaotic activity
P: QRS ratio: None
PR interval: None
QRS width: Normal
T wave: None; chaotic activity
ST-segment: None
QT intervals: None
Grouping: None
Dropped beats: None
Electrical axis: normal, right axis or left axis deviation
Diagnose the rhythm: Atrial Fibrillation
Justification for the diagnosis: This is the chaotic firing of the many pacemakers in the atrial haphazardly. There is, therefore, a discernible P wave with inverted ORS in an irregular form. The random intervals are as a result of the non-pacing of the ventricles.
Scenario 9)
A 33-year-old male consults his physician after having trouble exercising (shortness of breath, dizziness, tightness in his chest).
Rate: 9 x 10 = 90
Rhythm: irregular
P: QRS ratio: None in the VPC
PR interval: None in the VPC
QRS width: Wide (= 0.12 seconds), bizarre appearance
T wave: None in the VPC
ST-segment: None in the VPC
QT intervals: None in the VPC
Grouping: None
Dropped beats: None
Electrical axis: normal, right axis or left axis deviation
Diagnose the rhythm: Ventricular premature Contraction (VPC)
Justification for the diagnosis: The ventricular cell fires prematurely before the normal SA node causing the refractory state of the ventricles during the firing of the normal pacer. As a result, the ventricles contract irregularly creating a compulsory pause.
References.
Van Bemmel, J.H., Zywietz, C. and Kors, J.A., 1990. Signal analysis for ECG interpretation. Methods of information in medicine, 29(04), pp.317-329.
Lyon, A., Mincholé, A., Martínez, J.P., Laguna, P. and Rodriguez, B., 2018. Computational techniques for ECG analysis and interpretation in light of their contribution to medical advances. Journal of The Royal Society Interface, 15(138), p.20170821.
Willems, J.L., Abreu-Lima, C., Arnaud, P., Brohet, C.R., Denis, B., Gehring, J., Graham, I., Van Herpen, G., Machado, H., Michaelis, J. and Moulopoulos, S.D., 1990. Evaluation of ECG interpretation results obtained by computer and cardiologists. Methods of information in medicine, 29(04), pp.308-316.