electrocardiogram (ECG)

A 62-year-old man with a history of hypertension and type 2 diabetes mellitus presents to the emergency department complaining of palpitations and lightheadedness. He reports that the symptoms started suddenly about an hour ago. He denies any chest pain, shortness of breath, or syncope. His medications include metformin and lisinopril. On examination, he is alert and oriented. His blood pressure is 110/70 mmHg, heart rate is irregularly irregular at 140 bpm, respiratory rate is 18 breaths per minute, and oxygen saturation is 97% on room air. An ECG is performed, which shows an absence of P waves, irregularly irregular R-R intervals, and narrow QRS complexes. Which of the following is the most appropriate next step in the management of this patient?

A 58-year-old man presents to the emergency department with chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate immediate management?

A 68-year-old male presents for routine follow-up. He is asymptomatic. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medication. Review the provided image. What is the most appropriate next step in management?

A 72-year-old man with a history of type 2 diabetes mellitus, hypertension, and chronic kidney disease (stage 3) presents with a 2-week history of exertional dyspnea and fatigue. He reports no chest pain but has noticed occasional palpitations. On examination, his blood pressure is 150/90 mmHg, heart rate is 110 bpm (irregularly irregular), respiratory rate is 20 breaths per minute, and oxygen saturation is 94% on room air. Cardiovascular examination reveals a variable intensity S1, no S3 or S4, and a soft systolic murmur at the apex. Lung fields are clear. An ECG shows absent P waves and irregularly irregular QRS complexes. Which of the following is the most appropriate next step in management?

A 45-year-old male with a history of hypertension presents with recurrent episodes of palpitations and near-syncope. His ECG during an episode shows a wide QRS complex tachycardia with a rate of 220 bpm. There is no evidence of structural heart disease on echocardiography. Which of the following is the most likely underlying mechanism of his arrhythmia?

A 68-year-old woman with a history of heart failure presents to the emergency department with increasing shortness of breath and lower extremity edema. She has been taking furosemide 40mg daily for the past year. Her blood pressure is 110/70 mmHg, heart rate is 90 bpm, and respiratory rate is 24 breaths/min. An ECG shows flattened T waves and prominent U waves. Which of the following is the most likely electrolyte abnormality contributing to her presentation?

Reciprocal ST-depression with ST-elevation in leads II, III, aVF is most likely seen in which leads?

A 65-year-old man with a history of type 2 diabetes mellitus and hypertension presents with exertional dyspnea and fatigue. His physical examination reveals a blood pressure of 150/90 mmHg, a heart rate of 88 bpm, and a soft S4 gallop. There is no peripheral edema. An electrocardiogram shows left ventricular hypertrophy with repolarization abnormalities. Which of the following diagnostic tests would be most appropriate to evaluate for underlying coronary artery disease in this patient?

A 72-year-old woman is admitted to the cardiology ward following an episode of syncope. Her past medical history includes hypertension, for which she takes hydrochlorothiazide, and osteoarthritis, managed with regular ibuprofen. An ECG reveals a prolonged QTc interval of 520 ms. She denies any family history of sudden cardiac death or prolonged QT syndrome. Her electrolytes are within normal limits except for a potassium level of 3.4 mmol/L (normal range 3.5-5.0 mmol/L). Which of the following is the MOST appropriate initial step in managing this patient?

A 45-year-old man with a history of hypertension presents to the emergency department with palpitations and lightheadedness. His ECG shows a regular narrow-complex tachycardia at a rate of 180 bpm. There are no visible P waves, and the QRS duration is 0.08 seconds. He is hemodynamically stable. Which of the following is the most appropriate initial management?

A 78-year-old woman with a history of heart failure (reduced ejection fraction), type 2 diabetes, and recent hospitalisation for pneumonia presents to her GP with increasing fatigue and a single episode of dizziness leading to a fall without loss of consciousness. Her current medications are Digoxin 125 mcg daily, Furosemide 40 mg daily, Ramipril 5 mg daily, Metformin 500 mg BD, and Amoxicillin 500 mg TDS (started 5 days ago for pneumonia). An ECG in clinic shows sinus rhythm, rate 70 bpm, and a QTc of 530 ms. An ECG from 6 months prior had a QTc of 440 ms. Recent laboratory tests show Na 138 mmol/L, K 4.2 mmol/L, Mg 0.9 mmol/L, Ca 2.3 mmol/L, Creatinine 90 µmol/L, and Digoxin level 1.1 ng/mL. Considering the clinical context and investigations, which of the following is the most likely significant contributor to the observed QTc prolongation?

An electrocardiogram (ECG) shows a supraventricular tachycardia (SVT). What is the first-line treatment?

A 62-year-old man presents to the emergency department with a history of palpitations and dizziness that started suddenly 2 hours ago. He has a history of hypertension and is on lisinopril. He denies chest pain, shortness of breath, or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 150 bpm (irregular), respiratory rate is 18 breaths per minute, and temperature is 36.7°C. An ECG is performed, showing an irregularly irregular rhythm with no distinct P waves and a narrow QRS complex. Which of the following is the most appropriate initial management step?

A 72-year-old man with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presents to the emergency department complaining of exertional chest pain that has been increasing in frequency and severity over the past month. He describes the pain as a pressure-like sensation in the center of his chest, radiating to his left arm, and associated with shortness of breath. The pain typically occurs after walking two blocks and resolves with rest. He denies any recent changes in his medications or lifestyle. On examination, his blood pressure is 150/90 mmHg, heart rate is 78 bpm, and oxygen saturation is 96% on room air. An ECG shows normal sinus rhythm with no acute ST-segment changes. Troponin levels are within normal limits. Which of the following is the MOST appropriate next step in the management of this patient?

A 35-year-old patient with schizophrenia is on risperidone and develops QT prolongation on ECG. What is the next step?

A 67-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. His blood pressure is 180/100 mmHg in the right arm and 160/90 mmHg in the left arm. He has a history of hypertension and is a smoker. An ECG shows no acute ischemic changes. What is the most appropriate next step in the management of this patient?

A 55-year-old male presents with chest pain that radiates to his left arm and jaw, accompanied by diaphoresis and nausea. ECG shows ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?