83 year old woman with very long history of palpatations

Presenting in the evening with shortness of breath the patient explains she used to get palpatations every few months "for a very long time" but now she just gets paroxysmal SOB.
At presentation, she was symptom free. This was her ECG.

She is normotensive, has clean pathology, clear chest and no cardiac murmur. Echo showed mild mitral regurge, trivial TR, AR and LVH. As the lady had no one to go home to, she was admitted. During the night she called in the nurse with her usual symptoms. Her ECG is as follows:

Now what do we have here?

75 year old male with severe dyspnoea

Having never been to a doctor in his life, this gentleman was very hesitant about receiving treatment after his wife brought him into the hospital with severe SOB, getting worse by the day.
O/E he has a VERY loud, split systolic turbulence that masks a possible holosystolic murmur at the apex. He has bilateral crackles and is peripherally cyanotic, using all of his accessory muscles.

This ECG is performed:

Systematically, what does this ECG show?
What could be causing these obvious ECG abnormalities?
Every precordial lead (particularly V1-V4) shows an abnormality or phenomena called...?

50 year old female complaining of frequent AICD shocks

After 4 shocks over an hour from her 2 year old automatic internal cardiac defibrillator (AICD), the patient called an ambulance. On arrival to the ED, she explains that she gets VT but says that she doesn't know why and it generally only makes her feel a bit dizzy for the first 20 minutes or so. This time however, she had passed out each time before she was shocked.
She is sent to cardiology and her chart reveals her to have Idiopathic VT and the only treatment provided was the AICD.

A 12 lead ECG if found from a previous admission...

 

 a new one is is performed, and...

 

 12 lead ECG monitoring by your friends in the cardiac sciences department catch the arrhythmia brilliantly (in both standard 25mm/s...

 

  and slow 100mm/s format.

What are your thoughts?
What is the tachycardia?
From the first two ECGs, can you guess a likely diagnosis/cause of this lady's tachyarrhythmia?
And for the electrophysiologists in the audience, where is this arrhythmia arising from?

17 year old Female with black-outs and SOBOE

Presents to ED after a seizure like episode, when she regained consciousness it took around 30min to 'catch her breath'. She had been diagnosed with asthma from an early age but even with Rx was not able to participate in physical activities.
O/E she had no heart murmur and only a slight wheeze, she felt fine at the time. She is not on any medications apart from relieving and preventative asthma inhalers.

FHx was spotty due to poor communication with foreign relatives.

This ECG was obtained.
What abnormalities are seen here?
What could these indicate?
What investigations should be conducted?
What Rx should be considered?

17 year old female with presyncope

A young lady presents with frequent dizzy spells associated mainly with physical activity and stress.
She appears healthy and has never had any other complaints or medical conditions. Among other things, this ECG is obtained.

The ECG has 3 diagnostic markers for her cardiac condition present. What is not present (which is common) is axis deviation.
What are they? What does she have?

25 year old male with SOBOE

25 year old male smoker of Pacific Island decent presents for a checkup with increasing shortness of breath on exertion. Pt has no relevant medical history but thinks his grandfather and cousin died in their late 20s suddenly and unexpectedly.
What do you see?
What are your differential diagnoses?

 Answer to come...

49 year old wakes with palpitations

49 year old male with history of intermittent palpitations interpreted by GP as atrial fibrillation/flutter, severe sleep apnoea (refuses to use continuous positive airway pressure machine) and dilated cardiomyopathy (of possible alcohol or tachyarrhythmia origin) with a recent ejection fraction of around 40-45% calls the ambulance after waking with severe palpitations and shortness of breath. He explains he has had the same palpitations wake him once or twice a week for the last month but they only ever last a few minutes. After his Temazepam ran out the night before the man had trouble getting to sleep that night and when his sleep was disturbed by the intense palpitations it took an hour of symptoms before his wife found him and called an ambulance.
State ambulance service arrives to see the man pacing the room attempting to breath deeply while his wife encourages him to relax.
This ECG is recorded:

The man is in mild distress, has a strong palpable pulse, tachypnoeic at 38 breaths a minute and his manual blood pressure initially reads 215/119 mmHg.

Analise this ECG: Rate, rhythm, P waves, QRS, ischaemia...etc
What are the differential diagnoses?
What is the most likely scenario based diagnosis? and how about the electrocardiographical signs?

Will update soon...

62 year old male for DCCV

61 year old male arrives to your unit for an elective cardioversion (DCCV). His chart has not arrived yet but he tells you he has had palpitations on and off for years that have ended him up in the ED numerous times and he has had a device (pacemaker and/or defibrillator) inserted (his X-ray shows a single ventricular lead).
You take this ECG knowing that if he isn't in a cardiovertable rhythm, you need to discharge him.

Analyse this ECG.

What is the rhythm?

From his ECG findings, can you make an educated guess as to what device he has insitu and whether or not it is active on this ECG?

Can you guess what drug he may well be on for his atrial fibrillation to put him into this rhythm?

Are you going to discharge this man?

Answer to come!

42 year old with stabbing chest pain

A 42 year old man presents to the emergency department around midnight after playing soccer with some friends. Through mime and smartphone he is able to complain of intermittent stabbing chest pain around the position of ECG lead V4. The patient is new to the country and doesn't speak English very well but does have a medic-alert bracelet that is translated: "Allergy to shellfish. Stents in heart."
This ECG is performed and  placed in front of you, what is going on here?

Answer to come!

52 year old male with Chest pain

52 year old male arrives at emergency department after 1 hour of intense chest pain, diaphoresis and nausea, followed by vomiting. ED nurses take ECG as above and provide GTN, morphine and anti-emetic with no effect. What is happening?

Answer to come...

40 year old male with Syncope

40 year old male has noticed a slowly increasing dyspnoea on exertion and more recently, syncopal episodes. The only cardiac relevant history is dislipidaemia. He does report however that his father started to get tired and short of breath in his forties and died suddenly in his fifties.

Exam shows no JVP distention, clear lungs bilaterally and dual heart sounds with a loud systolic murmur.
Systematically, what does this ECG show? What is this patient at high risk of? what are the differentials and most likely diagnosis?