Plato's Nous

This 96 year old man was taken to the Emergency Department (ED) after an unwitnessed fall at his Nursing Home. He sustained a lacerated scalp. He is not on any anticoagulant drugs. He suffers from moderate dementia, and has recurrent falls. 

In the following cases you are given clinical details (Stem) and an ECG for analysis. You may be given additional information e.g X-rays or CT scans or blood test results.

This week we catch up with Bones and meet a man with a broken bone who has a potentially arrhythmogenic heart.

These tracings are from a elderly man who presented with a acute myocardial infarct (AMI) in 1982. This was when I began to collecting interesting or puzzling or intriguing ECGs. This was also the era of "roll your own ECG"

The patient is a 24 year old Sri Lankan man with a 4 day history of increasing dyspnoea, with exercise tolerance limited to 200 metres. He has not had a cough or chest pain or fever.  Four weeks ago he had a self-limited influenzal type illness.

This is the first of three cases with a theme of T wave changes...

Vladimir is a 77 year old man with a history of hypertension and mitral valve replacement that requires anticoagulation with warfarin.

This 21 year old man was found lying on the ground next to a bus stop at 0620 hours on a Sunday morning where the minimum overnight temperature was 60 C. An ambulance was called, and their findings on arrival were

Before the formation of the Australasia College of Emergency Medicine (in 1983) the hospital treatment of acute medical or surgical illnesses or injuries was carried out in so-called "Casualty Departments". These are now called "Emergency Departments"

The most likely mechanism of the tachycardia in the previous case is atrial flutter with an initial 2:1 atrioventricular (AV) conduction, followed by 1:1 AV conduction that produced the BCT (because of aberrant conduction). 

The patient is a 28 year old male with no known history of heart disease. He is being treated with sodium valproate for epilepsy.

The body is a complex and marvellous thing. In the words of Nathanael West (1903-1940):  "Under the skin of man is a wondrous jungle where veins like lush tropical growths hang along over-ripe organs and weed-like entrails writhe in squirming tangles of red and yellow". 

We are very familiar with the term "electricity", but we do not have an in-depth understanding of its “nature” or its “workings”. However we are all aware that an “electric shock” or a "lightening bolt" can produce a range of effects that range from a minor tingle to a “jolt” to major burns to death. 

For each of the following ECGs select the most appropriate finding(s) from the list below. Each option may be used once, more than once or not at all.