ECG cases
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Two falls this week, no memory of hitting the ground
HTN on amlodipine only. No known heart disease. Two falls in 5 days, both standing, no prodrome, no memory of landing. Bruised forehead. Alert now, no chest pain. K+ 4.3, TSH…
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Indigestion
HTN, T2DM (metformin, ramipril). Smoker, 15/day. No known heart disease. Heavy retrosternal pressure from 03:00, thought indigestion. Presented 9 h after onset when found grey and…
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Sudden headache at the gym, now drowsy
A 54-year-old woman was lifting weights when she had a sudden, severe occipital headache, the worst of her life. She vomited twice and briefly lost consciousness. She has no chest…
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Three months of the heartbeat stumbling, with an occasional sensation that it stops
No cardiac history. Drinks four coffees a day. No syncope, no chest pain, no breathlessness. The pulse is irregular at rest. Examination is otherwise normal. Potassium, magnesium…
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Central chest tightness and breathlessness for two hours
Smokes fifteen a day. No regular medication and no previous cardiac history. Flew back from a conference in Singapore three days ago. The tightness came on while he was sitting at…
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Sharp central chest pain for two days, worse lying flat
A head cold and sore throat the week before. No cardiac history. No regular medication other than the combined oral contraceptive, stopped four years ago. Ingrid Haugen walked…
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Central chest heaviness with nausea for ninety minutes
Smokes twenty a day. No regular medication and no rate-limiting drugs. Brought in by ambulance; the pain started while he was carrying boxes and has not eased. Gareth Whitlock is…
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Breathlessness climbing stairs, worsening over six months, with ankle swelling
Treated hypertension on amlodipine and a small dose of ramipril, both of which have had to be reduced twice this year for dizziness. Bilateral carpal tunnel decompressions at 74…
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Dizziness and two near-faints since this morning
Lives alone and independent. Treated hypertension on amlodipine only — no beta blocker, no rate-limiting calcium blocker, no digoxin and no antiarrhythmic. No chest pain and no…
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Palpitations on and off for three weeks, now persistent for two hours with mild breathlessness
Non-smoker, no cardiac history. Takes no regular medication. She has lost three kilograms over six weeks without trying and reports feeling hot and restless. No syncope, no chest…
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A thumping in the chest when he lies down at night, going on for months
Fit, plays football twice a week and has never had symptoms while running. No blackouts. No family history of sudden death. Takes nothing; drinks little coffee. He is well, with a…
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Collapsed at the kitchen sink with no warning, out for a few seconds
Paroxysmal atrial fibrillation on apixaban. Treated hypertension. Bisoprolol increased from 2.5 mg to 5 mg three weeks ago for palpitations. Two similar collapses in the past…
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Two episodes of sudden loss of consciousness
Retired carpenter. Hypertension treated with amlodipine. No previous cardiac history. His wife witnessed two brief episodes of syncope today, each lasting about ten seconds, with…
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Collapse on the cardiology ward
Admitted twelve days ago with an inferior STEMI treated with primary PCI to the right coronary artery. Started on sotalol 80 mg twice daily five days ago for recurrent…
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Progressive exertional breathlessness and one episode of near-syncope
Systemic sclerosis with known pulmonary arterial hypertension. No sudden pleuritic pain and no acute change in symptoms. She is stable at rest. The ECG is recorded during routine…
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Rapid regular palpitations for two hours
No significant past medical history. Takes no regular medication. Presented to the emergency department with a two-hour history of sudden-onset palpitations. He is…
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Light-headedness on standing for two days, with one unwitnessed collapse
Forestry worker, no regular medication, no cardiac history. Removed a tick from her thigh six weeks ago and had an expanding red rash around the bite that faded without treatment.…
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Intermittent palpitations noticed during a night shift
No structural heart disease. She drinks several energy drinks during night shifts and takes no regular medication. She is comfortable and the pulse feels irregular in a repeating…
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Recurrent chest pressure at rest since early morning
Hypertension and dyslipidaemia. The first pain episode resolved before the ambulance arrived; the pain returned in triage. Pain is present during this recording. The initial…
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Weakness and palpitations after rapid weight loss for a boxing weigh-in
He has lost 7 kg in twelve days by restricting food and fluids, inducing vomiting and using stimulant laxatives. He takes no prescribed medication and has no known cardiac…
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Breathlessness during a viral chest infection
Dilated cardiomyopathy with a documented left bundle branch block. No chest pain and no syncope. She is mildly breathless but haemodynamically stable.
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Central chest pain for forty minutes, still present
Smokes fifteen a day, no other history and no medication. Father died of a heart attack at 46. The paramedic tracing was transmitted and reported as no ST elevation, so he was…
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Lightheadedness and palpitations for three days
Forestry worker. Spent August clearing scrub; treated an expanding red rash on the thigh himself with antiseptic cream about four weeks ago. No regular medication, no drugs, no…
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Found drowsy at home with an empty packet of her own tablets
Amitriptyline for post-herpetic neuralgia and ramipril for hypertension. Lives alone, no cardiac history, no previous overdose. Bronwen Ellis was found by her daughter at midday…
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Epigastric pressure and nausea for four hours
Type 2 diabetes on metformin, hypertension on ramipril and indapamide. Ex-smoker. Seen at an out-of-hours clinic two hours ago and given omeprazole for indigestion; no ECG was…
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Two episodes of near-fainting today, the second while sitting down
Single-chamber pacemaker implanted four years ago for sinus node disease. Hypertension on ramipril; also takes aspirin and atorvastatin. No beta blocker, no calcium channel…
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Monitor alarm during a laparoscopic operation
Dual-chamber pacemaker implanted four years ago for complete heart block after aortic valve replacement, pacing-dependent at her last device check. Bisoprolol and apixaban, the…
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Central chest tightness during a five-a-side football match, settled after twenty minutes
Kwabena Mensah, warehouse team leader, plays football twice a week. No cardiac history, no diabetes, no family history of sudden death. Takes no regular medication. The paramedics…
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Abnormal monitor tracing noted on the post-operative ward round
Eileen Kavanagh is on day 2 after a cemented hemiarthroplasty for a fractured neck of femur. Febrile overnight with a productive cough; antibiotics for a hospital-acquired…
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Vomiting and clamminess for an hour, with a heavy feeling across the chest
Type 2 diabetes on metformin, hypertension on amlodipine. Smokes fifteen a day. Walked into his rural GP surgery, who called an ambulance when the practice nurse could not find a…
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Blackout in a supermarket queue, with no warning
Hypertension on bisoprolol for years. Donepezil started six weeks ago for early Alzheimer's disease. Two episodes of feeling faint in the last month; this time he went to the…
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Dizzy standing up, twice in the last week
Dual-chamber pacemaker four years ago for sinus node disease. Takes doxazosin and indapamide for blood pressure, and amitriptyline at night for neuropathic pain, doubled by her GP…
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An irregular pulse at a pre-employment medical
A 34-year-old man is seen for a pre-employment medical. He has no complaints, takes nothing, and cycles about 200 km a week. He has never blacked out, and has never noticed his…
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Palpitations and breathlessness that began during a football match an hour ago
Fit and well, no regular medication. Two shorter episodes of racing heartbeat over the past year, both stopped on their own before he reached a doctor. Kwabena Asare walked into…
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Palpitations that started suddenly during a lesson
Primary school teacher, well, no medication apart from the contraceptive pill. Two similar episodes in the past two years, both stopping on their own within twenty minutes. Two…
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Palpitations for three weeks, worse over the last two days
No cardiac history and no regular medication. Six kilograms of unintended weight loss since the spring, heat intolerance and a fine tremor. Referred by her GP as fast atrial…
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Sharp central chest pain for a day, worse lying flat
Fit and well, no medication. A week of sore throat, aches and fever that was settling until the chest pain began. Sent in by the university health service. The nearest primary PCI…
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Monitor alarm on the coronary care unit
Day one after primary PCI to the left anterior descending artery for an anterior infarct. On aspirin, ticagrelor, bisoprolol and atorvastatin. Pain free since the procedure…
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Two days of vomiting, poor appetite and confusion
Permanent atrial fibrillation on digoxin 125 micrograms daily, bisoprolol and apixaban. Chronic kidney disease with a baseline creatinine of 110 umol/L. Started clarithromycin…
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Weakness and vomiting for three days
Heart failure with reduced ejection fraction, on ramipril, spironolactone, bisoprolol and furosemide. Type 2 diabetes on metformin. Has been vomiting and passing loose stool since…
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Sudden palpitations and light-headedness on the assessment unit
Anterior myocardial infarction six years ago, treated with primary PCI to the LAD. Takes bisoprolol, ramipril, atorvastatin and aspirin. Admitted this morning with two weeks of…
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Collapse in the waiting room, three days into a diarrhoeal illness
Takes citalopram 40 mg daily for depression. Three days of vomiting and diarrhoea after a family barbecue, eating and drinking almost nothing. Given ondansetron 4 mg intravenously…
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Central chest pain for two hours, still present
Left bundle branch block documented three years ago during an outpatient work-up for breathlessness; no ischaemia found at the time. Hypertension on indapamide, type 2 diabetes on…
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Presyncope, and a pulse of about thirty
A 78-year-old woman is brought in after two episodes of feeling about to faint, both while standing at the kitchen sink. She did not lose consciousness and did not fall. She takes…
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Every tracing here was generated, not recorded. Each one opens in the studio with every dial live.