ECG Cases Case 1This ECG was recorded from a 20-year-old student who complained of an irregular heartbeat. Apart from an irregular pulse, her heart was clinically normal. What do the ECG and chest X-ray show and what would you do? Case 2A 60-year-old man was seen as an outpatient, complaining of rather vague central chest pain on exertion. He had never had pain at rest. What does this ECG show and what would you do next? Case 3An 80-year-old woman with prior episodes of dizziness fell and fractured her hip. Her pulse is slow, and her ECG is shown. Surgeons want urgent surgery, but the anaesthetist is concerned. What does the ECG reveal, and what is the recommended action? Case 4A 50-year-old man presents to A&E with severe central chest pain lasting 18 hours. His ECG is shown. What does it indicate, and what is the next step? Case 5 An ECG was recorded from a medical student during a practical session. What does it show? Case 6A 26-year-old woman with a history of palpitations presents to A&E with another episode. Her ECG is shown. What does it reveal, and what is the appropriate management? Case 7A 60-year-old man presents to A&E with severe central chest pain for 1 hour. His ECG is shown. What does it indicate, and what is the appropriate management? Case 8A 70-year-old man is admitted with sudden severe central chest pain. His ECG is shown. What does it reveal, and what treatment is required? Case 9 A 70-year-old man is admitted with sudden severe central chest pain. His ECG is shown. What does it indicate, and what treatment is required? Case 10A 50-year-old man presented to A&E with chest pain and collapsed during ECG recording. What likely happened, and what is the immediate management? Case 11A 55-year-old man presents to A&E with 6 hours of chest pain at rest. Physical exam is normal, and troponin is negative. His ECG is shown. What does it show, and how should he be managed? Case 12A 40-year-old woman experienced palpitations during this ECG recording. What abnormality is seen? Case 13A 40-year-old woman is referred for increasing breathlessness. Her ECG and chest X-ray are shown. What do they reveal? What physical signs might be present, what is the likely diagnosis, and how should she be managed? Case 14An 80-year-old man presents with gradually worsening breathlessness and ankle swelling over months. He has a slow pulse, signs of heart failure, and no chest pain. His ECG is shown. What does it reveal, and how should he be managed? Case 15 A 40-year-old man was urgently admitted with sudden symptoms of severe left ventricular failure. His ECG is shown. What does it reveal, and what is the appropriate management? Case 16A 50-year-old man is urgently admitted with 4 hours of chest pain typical of myocardial infarction. Physical exam is normal. His ECG is shown. What does it indicate, and what is the appropriate management? Case 17A 75-year-old woman reports central chest discomfort and dizziness on exertion, with one episode of fainting. Her ECG is shown. What abnormality does it reveal, and what physical signs should be assessed? Case 18A 48-year-old man presents with 1 hour of severe central chest pain. His ECG is shown. What does it indicate, and what is the appropriate management? Case 19A 20-year-old student reports yearly episodes of sudden-onset palpitations with a fast, regular heartbeat, breathlessness, and near-syncope. Episodes resolve abruptly within minutes. Examination is normal. His ECG is shown. What is the likely diagnosis, and how should he be managed? Case 20A 50-year-old man is urgently admitted with 4 hours of chest pain typical of myocardial infarction. Physical examination is otherwise normal. His ECG is shown. What does the ECG indicate, and what is the appropriate management? Case 21A 70-year-old woman is admitted with worsening congestive cardiac failure. Her ECG is shown. What does this ECG show and what would you do next? Case 22A 70-year-old man presents to the outpatient clinic with signs and symptoms of heart failure. His condition began suddenly a few weeks ago, following a brief episode of dull central chest discomfort. His ECG and a magnified section of his chest X-ray are provided. What do the ECG and chest X-ray findings suggest, and how should he be managed? Case 23An 80-year-old woman with a history of chronic heart failure presents with nausea and vomiting. No prior medical records are available. Her ECG is shown. Can the ECG assist in guiding her management? Case 24An 80-year-old patient is admitted unconscious with a suspected stroke. The ECG is puzzling to the senior house officer. What might have been missed during the initial assessment—such as physical examination or chest X-ray—and how could these findings alter the diagnosis or management? Case 25A 60-year-old man was seen as an outpatient, complaining of rather vague central chest pain on exertion. He had never had pain at rest. What does this ECG show and what would you do next? Case 26A 50-year-old man returns from a holiday in France. He reports an episode of severe indigestion while abroad but currently feels well. His ECG is shown. What does the ECG reveal, and what is the appropriate management? Case 27A 45-year-old man in the Coronary Care Unit with suspected myocardial infarction suddenly develops breathlessness and hypotension. His ECG is shown. What does the ECG reveal, and what is the appropriate management? Case 28 A 50-year-old man is admitted with chest pain. He was unaware of a rapid heart rate. He has had multiple episodes of ischemic-type chest pain, unrelated to exertion. Shortly after this ECG was recorded, his heart rate slowed and the ECG normalized. What does this ECG reveal, and what is the appropriate management? Case 29A 60-year-old man had an episode of chest pain one year ago. He now presents with breathlessness and occasional dizziness. What does this ECG show and what would you do next? Case 30A 70-year-old woman reports recurrent “dizzy turns.” On examination, her pulse is irregular. Her ECG is shown and reveals three abnormalities. What are the three ECG abnormalities, and what advice or management would you recommend?
