ECG 340 A 77-year-old male who is seen for a comprehensive physical examination. He has a known history of ischemic heart disease including a past myocardial infarction. He feels well at present, devoid of cardiac symptomatology.

ECG 341 A 72-year-old male with known coronary artery disease and two past myocardial infarctions, last in the left anterior descending coronary artery distribution approximately 3 years prior to this electrocardiogram.

ECG 342 A 53-year-old male with diffuse coronary artery disease status post inferior and anterior myocardial infarctions 15 years prior to this electrocardiogram who returns for routine cardiology follow-up. Subsequent to the myocardial infarctions, the patient underwent ventricular aneurysmectomy. He continued with symptoms of stable angina pectoris in the setting of mild mitral insufficiency and moderate left ventricular systolic dysfunction. His medications included digoxin, furosemide, and captopril.

ECG 343 A 55-year-old female with known coronary artery disease and past intracoronary stent placement to the left anterior descending coronary artery who noted the acute onset of chest discomfort 1 day following colorectal surgery. This electrocardiogram was obtained while the patient was an inpatient shortly after her symptoms began and reflected a distinct change from her preoperative electrocardiogram. She was acutely taken to the cardiac catheterization laboratory where a stent was placed to her proximal left anterior descending coronary artery in the setting of an occlusive thrombus, just proximal to her previously placed stent.

ECG 344 A 78-year-old male with known coronary artery disease who suffered a myocardial infarction 2 years prior to this electrocardiogram.

ECG 345 A 73-year-old male with coronary artery disease and severe ischemic left ventricular systolic dysfunction who returns for a follow-up evaluation of recurrent congestive heart failure. Comorbidities include hypercholesterolemia, insulin-requiring diabetes mellitus, hypertension, and peripheral vascular disease. Medications at the time of this electrocardiogram included thyroxine, metolazone, digoxin, furosemide, captopril, and procainamide.

ECG 346 A 67-year-old male with coronary artery disease and ischemic left ventricular systolic dysfunction who is status post percutaneous coronary intervention to his left anterior descending coronary artery who returns for outpatient follow-up. This is in the setting of recently detected ventricular tachycardia and implantable cardiac defibrillator placement.

ECG 347 A 69-year-old male with recent symptoms of lightheadedness.

ECG 348 A 74-year-old male who is referred for a preoperative cardiac evaluation prior to planned knee replacement surgery. The patient has a pertinent past cardiac history including coronary artery bypass graft surgery 1 year prior to this electrocardiogram. A subsequent electrophysiology study demonstrated non-sustained ventricular tachycardia without inducible sustained cardiac dysrhythmias. Medications at the time of this electrocardiogram included potassium, digoxin, furosemide, simvastatin, captopril, and aspirin.

ECG 349 A 71-year-old male with known persistent atrial fibrillation and coronary artery disease, status post remote coronary artery bypass grafting with more recent percutaneous coronary interventions who is seen in the outpatient department following a recent hospitalization for newly diagnosed acute decompensated systolic congestive heart failure. The patient returns at the time of this 12-lead electrocardiogram subjectively improved to his normal functional baseline.

ECG 350 An 84-year-old male postoperative day 1 partial colon resection with acute-onset severe shortness of breath and chest discomfort.

ECG 351 A 76-year-old male with esophageal carcinoma status post esophagectomy who presents for outpatient follow-up. His past history includes coronary artery disease. He is status post coronary artery bypass graft surgery 12 years prior to this electrocardiogram. He also is known to suffer from chronic atrial fibrillation.

ECG 352 A 54-year-old male with a history of hypertension, coronary artery disease, and diabetes who returns for outpatient internal medicine follow-up. He feels well at the present time and verbalizes no concerns. He is unaware of any heart rhythm irregularity.

ECG 353 A 54-year-old female who had this electrocardiogram performed as part of a physical examination. She presently feels well without cardiovascular symptoms.

ECG 354 A 73-year-old female with a history of aortic stenosis and hypertension who is readmitted to the hospital with shortness of breath secondary to rectal bleeding. A recent echocardiogram demonstrated normal left ventricular systolic function and severe aortic stenosis. Medications at the time of this electrocardiogram included iron, topical nitroglycerin, digoxin, diltiazem, and atenolol.

ECG 355 A 42-year-old female who was scheduled for a recent elective gynecological procedure. As part of her preoperative evaluation, a 12-lead electrocardiogram was obtained. This was considered abnormal and officially interpreted as frequent premature ventricular complexes. The patient was referred for a cardiovascular medicine consultation. The patient feels well and remains asymptomatic from a cardiovascular medicine perspective.

ECG 356 A 73-year-old male who returns for an outpatient cardiovascular medicine follow-up evaluation. He feels well at the present time. He has known coronary artery disease and ischemic left ventricular systolic dysfunction.

ECG 357 A 74-year-old female with long-standing hypertension and hypertensive heart disease admitted from a nursing home for evaluation of a fever. Medications at the time of this electrocardiogram included diltiazem, aspirin, and levodopa.

ECG 358 An 86-year-old male with advanced coronary artery disease, two past coronary artery bypass grafting procedures, ischemic left ventricular dysfunction, and congestive heart failure who returns for outpatient cardiovascular medicine follow-up. His main concerns are fatigue, interrupted sleep patterns, and lower extremity fluid accumulation, refractory to a low-sodium diet.

ECG 359 A 66-year-old female with anterior precordial crushing pain of 45 minutes duration. She has known coronary artery disease.

ECG 360 A 55-year-old male with coronary artery disease and severe left ventricular systolic dysfunction status post coronary artery bypass surgery 3 years prior to this electrocardiogram. He is admitted to the hospital with a recurrent chest discomfort syndrome.

ECG 361 An 83-year-old male with known ischemic heart disease, status post two prior myocardial infarctions, coronary artery bypass grafting surgery, and a left ventricular ejection fraction of 20% who is acutely admitted via the emergency room with decompensated systolic congestive heart failure. The patient has noted over the past few weeks periods of intermittent rapid heart beating in the context of extreme lethargy and lightheadedness. His symptoms would spontaneously resolve within a few minutes. This electrocardiogram was obtained a few hours after hospital admission with accompanying symptoms similar to what he had been experiencing as an outpatient.

ECG 362 A 66-year-old female with known mitral regurgitation and a history of atrial arrhythmias who is presently postoperative day 1, status post colorectal surgery.

ECG 363 A 69-year-old female with advanced ischemic left ventricular systolic dysfunction status post multiple prior myocardial infarctions who presents for a routine outpatient cardiac follow-up evaluation. Other comorbidities include complete heart block status post permanent pacemaker placement, congestive heart failure, and hypertension. Medications at the time of this electrocardiogram included amiodarone, enalapril, digoxin, and furosemide.

ECG 364 An 88-year-old male admitted to the coronary intensive care unit after several implantable cardiac defibrillator discharges, profound hypotension, and positive cardiac biomarkers consistent with an acute coronary syndrome. The patient required intubation, mechanical ventilation, and intravenous inotrope and vasopressor support. This electrocardiogram was obtained shortly after hospital admission reflecting a change from his normally paced heart rhythm. The patient’s serum electrolytes including potassium and magnesium were normal earlier the same day. He demonstrated mild-to-moderate renal dysfunction.

ECG 365 A 56-year-old male with known coronary artery disease admitted to the hospital with unstable angina. The patient underwent left heart catheterization, angioplasty, and stenting to the proximal right coronary artery. This electrocardiogram was obtained 4 hours after the percutaneous coronary revascularization procedure was completed.

ECG 366 A 72-year-old female with prior inferior and anterior myocardial infarctions and resultant moderately severe depression of left ventricular systolic function who now presents for routine cardiology follow-up in the outpatient department. Comorbidities include hypertension, non-sustained ventricular tachycardia, and peripheral vascular disease.

ECG 367 A 29-year-old male with a history of syncope who returns for an outpatient cardiovascular medicine follow-up evaluation. A recent echocardiogram confirmed severe concentric left ventricular hypertrophy, biatrial enlargement, and right ventricular hypertrophy. He had normal biventricular heart function. Hypertrophic cardiomyopathy was suspected. He did not have a demonstrated left ventricular outflow tract gradient.

ECG 368 An 85-year-old male with acute chest pain and cardiogenic shock.

ECG 369 A 55-year-old male admitted to the hospital urgently with a recent-onset chest discomfort syndrome felt consistent with an acute myocardial infarction. The patient underwent a cardiac catheterization demonstrating a subtotal occlusion of the left anterior descending coronary artery. Serial cardiac enzymes documented acute myocardial injury. His post-myocardial infarction hospital course included recurrent ventricular tachycardia.

ECG 370 An 80-year-old male with a long history of ischemic heart disease, congestive heart failure, and atrial arrhythmias seen in follow-up outpatient cardiovascular medicine evaluation in the setting of recently detected paroxysmal atrial fibrillation. At the present time, the patient feels well and is not felt to be in a decompensated state.

ECG 371 A 76-year-old female with severe mitral regurgitation immediately postoperative mitral valve repair.

ECG 372 An 81-year-old female with a history of severe aortic stenosis status post bioprosthetic aortic valve replacement and a prior inferior myocardial infarction who returns for outpatient cardiology follow-up. She has ongoing fatigue but no symptoms suggestive of arrhythmias. Her medications included enalapril, digoxin, and aspirin.

ECG 373 A 53-year-old male admitted to the medical intensive care unit with gram-negative septicemia and hypotension who is presently mechanically ventilated. He has a long-standing history of insulin-requiring diabetes mellitus.

ECG 374 An 84-year-old male admitted to the hospital with acute decompensated systolic congestive heart failure. He has a known history of ischemic heart disease, past myocardial infarction, and left ventricular systolic dysfunction.

ECG 375 A 63-year-old female with a history of a remote myocardial infarction and coronary artery bypass graft surgery who returns for clinical evaluation in the setting of increasing dyspnea and progressive mitral stenosis. Her medications included bumetanide, lisinopril, potassium, and warfarin.

ECG 376 A 69-year-old female with severe nonischemic left ventricular systolic dysfunction with an estimated left ventricular ejection fraction of 10% admitted acutely to the coronary intensive care unit in the setting of recurrent palpitations and near syncope. She was also profoundly hypotensive requiring intravenous vasopressor support to maintain her blood pressure. Unfortunately, the patient expired shortly after this 12-lead electrocardiogram was obtained.

ECG 377 An 18-year-old male with an unrepaired ventricular septal defect, moderately severe pulmonary hypertension, and activity-related oxygen desaturation now being seen in follow-up outpatient evaluation.

ECG 378 A 65-year-old male with coronary artery disease status post remote coronary artery bypass graft surgery who was admitted acutely to the hospital with recurrent congestive heart failure. The patient has chronic atrial fibrillation and mitral insufficiency. He is status post permanent pacemaker placement for sick sinus syndrome. Medications at the time of this tracing included amiodarone, digoxin, isosorbide dinitrate, warfarin, and enalapril.

ECG 379 A 90-year-old female admitted to the hospital directly from her long-term care residence with acute pneumonia. She had undergone prior permanent pacemaker placement for symptomatic complete heart block.

ECG 380 A 52-year-old female who is postoperative day 2 status post mechanical aortic valve replacement secondary to congenital bicuspid aortic valve stenosis.

ECG 381 A 55-year-old male with an idiopathic dilated cardiomyopathy, congestive heart failure, and hypertension who returns for cardiology follow-up. His medications included warfarin, captopril, digoxin, furosemide, metoprolol, and sublingual nitroglycerin.

ECG 382 A 69-year-old female with symptomatically severe aortic valve stenosis and normal coronary arteries who underwent aortic valve replacement surgery 2 days before this 12-lead electrocardiogram was performed. The patient had persistent respiratory insufficiency and remained mechanically ventilated at the time of this electrocardiogram tracing.

ECG 383 An 81-year-old female with severe coronary artery disease who is postoperative day 3 after multi-vessel coronary artery bypass grafting. Both preoperative left heart catheterization and echocardiogram confirmed normal left ventricular systolic function.

ECG 384 A 67-year-old male referred for a cardiac catheterization in the setting of hypertension and recent symptoms of profound exertional dyspnea. Medications at the time of this electrocardiogram included digoxin, nifedipine, and aspirin. An echocardiogram demonstrated left ventricular hypertrophy with normal left ventricular systolic function and severe aortic stenosis. The cardiac catheterization demonstrated normal coronary arteries. The patient was referred for successful aortic valve replacement.

ECG 385 A 55-year-old male with a history of severe hypertension and acute ascending aortic dissection, status post urgent operative repair who returns for cardiovascular medicine follow-up. He has recently noted frequent fevers, a reduction of his appetite, and increasing fatigue. His physical examination is suspicious for a sternal wound infection. The patient was promptly hospitalized for intravenous antibiotics and wound exploration.

ECG 386 A 61-year-old male with known coronary artery disease acutely admitted to the hospital after experiencing an episode of syncope. The patient underwent successful permanent pacemaker placement with symptomatic improvement.

ECG 387 A 68-year-old male status post repair of an ascending aortic dissection with aortic valve resuspension and a single-vessel coronary artery bypass graft procedure 6 years prior to this electrocardiogram who returns for a cardiology follow-up examination. He is experiencing progressive dyspnea and weakness. Medications at the time of this electrocardiogram included furosemide, potassium, and metolazone.

ECG 388 A 66-year-old female who returns for outpatient cardiovascular medicine follow-up in the setting of recent open-heart surgery in the form of aortic valve replacement. The patient had previously been diagnosed with severe aortic stenosis due to a bicuspid aortic valve. She had been followed for quite sometime clinically, but for the few months prior to her open-heart surgery, she noted the onset of progressive exertional fatigue and shortness of breath. Transthoracic echocardiography demonstrated increased left ventricular mass and confirmed the presence of severe aortic stenosis. Her open-heart surgery transpired without complication.

ECG 389 A 60-year-old female with nonischemic severe left ventricular systolic dysfunction who is status post a heart transplantation procedure 2 years before this electrocardiogram was obtained.

ECG 390 A 70-year-old male who is status post recent mitral valve repair secondary to severe mitral valve prolapse and mitral insufficiency.

ECG 391 A 71-year-old male with recurrent diverticulitis who presents for a preoperative cardiovascular medicine assessment prior to near-future planned sigmoidectomy. At the present time he feels well, walks long distance for exercise, and voices no cardiac concerns.

ECG 392 An 82-year-old male with known coronary artery disease, status post a myocardial infarction 3 years prior to this electrocardiogram who returns for outpatient department follow-up. He feels well and has no cardiopulmonary symptoms at this time.

ECG 393 A 56-year-old male with severe ischemic left ventricular systolic dysfunction admitted to the hospital for evaluation of near syncope. His echocardiogram demonstrated a left ventricular aneurysm. This patient underwent coronary artery bypass graft surgery 3 years prior to this electrocardiogram. Medications at the time of this tracing included captopril, aspirin, and digoxin.

ECG 394 A 68-year-old female with a history of breast cancer who returns for an every 6-month oncology follow-up assessment. She feels well and remains reasonably active without cardiac concerns. Two years before this electrocardiogram, she received chemotherapy for her breast malignancy. Unfortunately, this was associated with nonischemic left ventricular systolic dysfunction and advanced heart block, the latter requiring permanent pacemaker placement.