12 Lead EKG interpretations: let's do it!!!

[TomB]

It is not a totally normal ECG. It shows a repolarization abnormality, a downsloping ST-segment in lead III, and a flat ST-segment in lead aVF. If it was the ECG of a chest pain patient it would be suspicious, but inconclusive.

Tom

 

[Dutch-EMT]

Thanks, that was my only guess. I got one to post I found. I had to get out my little als book and measure it, and I still got it wrong.

1. Heartrate: about 75 bpm
2. Rhytm: regullar
3. P's are looking the same. negative in V1. P's followed by a QRS.
4. PQ time is normal, QRS time doubts me. Looks a little wide, BBB?... The R's don't show up very well...
5. Heartaxis: I = positive and aVF negative : left axis deviation.
6. Hypertrophy, no LVH, RVH or Atrial hypertrophy.
7. Q's and ST's normal. T's normal, flat T in V1.

So based on the information: low R in the precordial leads , left axis deviation... the wide looking QRS tells me there is a intraventricular conduction problem...
Left axis tells me it is possible anterior (also the S in III).
But with no signs of Q's, ST's and T's it isn't MI.
So, it is possible that it is Left anterior fascicular block.

 

[DV_EMT]

On the second one, looks like it could be an electrolyte imbalance causing a spiked T wave.

 

[SeeNoMore]

This is a great thread though as a new medic student I can not believe I will someday be able to interpret these. Who knows, with the fail rates in paramedic school maybe I wont:excl:


Thanks for posting it though

 

[Dutch-EMT]

A new one...

Okay, ECG number 3: A young male, 26years...
Any problems on this one?

 

[Shishkabob]

NSR with ST-elevation in V2-V4 leading to a possible septal infarct.

Can't quit tell so zoomed out, but there might be a mm of elevation in V1, which would then make it a possible anterio-septal infarct.

 

[8jimi8]

NSR with ST-elevation in V2-V4 leading to a possible septal infarct.

Can't quit tell so zoomed out, but there might be a mm of elevation in V1, which would then make it a possible anterio-septal infarct.

I thought ST elevaton less than 1 mm was insignificant?

 

[Shishkabob]

Which is why I said there might be 1mm elevation but I wasnt too sure

 

[8jimi8]

i meant to say less than 2 mm, but you seemed to imply that if it was there, it would increase the size of the infarct...

or am i reading your post incorrectly?

I was just looking for rationale as to why you felt that 1mm ste was significant...

(not that it absolutely cannot be... just curious as to what you are thinking)

 

[Shishkabob]

I was always taught 1mm / .5mm for elevation and depression respectively, was where a possible ischemic event was taking place.



EDIT: Hmph, reading in a couple of places say precordial leads need 2mm elevation... wheres my Dubin book when I need it?

 

[8jimi8]

yah...

>2mm ste in the precordials is what I learned. That is why I was curious, being that you just finished school, i didn't know if you were working with new infos.

 

[Shishkabob]

Could also be because I finished school I have a crap load of info and very little experience, so it all gets jumbled ^_^



Could have just been the limb leads I was thinking of... gah, now I have to find my cardiology notes. Thanks, James, for ruining my lazy day!

 

[Dutch-EMT]

EDIT: Hmph, reading in a couple of places say precordial leads need 2mm elevation... wheres my Dubin book when I need it?

When the ST elevation / depression is the only sign pointing to a possible MI, that means no Q's, no typical complains (chestpain) or other signs/symptoms, then the elevation or depression must be 2mm or more...
0,5 or 1mm elevation/depression are mostly insignificant.
The patiënt monitors I use alarm for ST at 2mm elevation or depression...

 

[Shishkabob]

I found this interesting-

http://www.slideshare.net/cksheng74/st-segment-elevations-in-ecg2

Look at slide page 9.

As per the 2007 AHA/ACC MI guidelines at http://content.onlinejacc.org/cgi/content/full/50/7/e1

. The diagnosis of MI is confirmed with serial cardiac biomarkers in more than 90% of patients who present with ST-segment elevation of greater than or equal to 1 mm (0.1 mV) in at least 2 contiguous leads, and such patients should be considered candidates for acute reperfusion therapy.

 

[8jimi8]

I found this interesting-

http://www.slideshare.net/cksheng74/st-segment-elevations-in-ecg2

Look at slide page 9.

As per the 2007 AHA/ACC MI guidelines at http://content.onlinejacc.org/cgi/content/full/50/7/e1

Good Info! I am a fan of POC Biomarkers.

anecdotally... where I work, no MD would change any orders for a 1mm elevation other than ordering serial CEs every 6 hours.

Unless the patient is symptomatic.

 

[Dutch-EMT]

Well, good information!!! Sheet 4 tells also something interesting:
"Of 123 adult chestpain patiënts with ST segment elevation equal or >1mm, 51% did not have myocardial infarctions. 21% LBBB and 33% LVH"...
Sheet 5 tells more reasons for ST elevation, for example Benign early repolarization. So that means it can be a harmless sign.

But, hey... let's go ontopic again with ECG nr 3 I posted.
I agree that the ST in V2 and V3 is elevated. but anything more interesting to see?

for the sake of convenience: here it is (again)

 

[MrBrown]

Our guideline is >= 2mm

I'll try one ... this was a 19yof cc c/p ~ 7/24 maybe 2 or 3/10 other than that asymptomatic

I don't have the 12 lead ECG with me still so I found a comparable one online

 

[Shishkabob]

@Dutch-EMT

Seems sinus brady, or very close to it, not normal sinus like I said before. I didn't count the boxes >_>

 

[Dutch-EMT]

@Dutch-EMT

Seems sinus brady, or very close to it, not normal sinus like I said before. I didn't count the boxes >_>

It is a sinusrythm, about 60 bpm.
The ST's in V2 and V3 in this case were'not significant for diagnose of any MI.
Heartaxis is normal and there is no significant Q in the ECG.

Again a normal ECG belonging to this specific (sportive, young) person.

 

[Dutch-EMT]

Our guideline is >= 2mm

I'll try one ... this was a 19yof cc c/p ~ 7/24 maybe 2 or 3/10 other than that asymptomatic

I don't have the 12 lead ECG with me still so I found a comparable one online

Missing V4-V6... can you post thos missing leads?

1 Heartrate: 90bpm
2 Rythm: P followed by QRS, so sinusrythm
3 P looks very large in all leads... Different shapes in the various leads...
4 PQ is not larger than 0,2 sec so normal. QRS <0,12 sec.
5 Axis: I more negative, aVF more positive... right axis deviation
6 Hypertrophy: P in V1 looks like right-atrialhypertrophy.
Need V4 - V6 to review if this ECG shows ventricular hypertrophy.
7 Q in III, aVF, V1 V2 and V3. Q in II doubts me... 1mm wide or 1/3 of the QRS? ST depression in II (1,5 or 2mm), 1mm depression in aVF. Flat T in V1.

But i realy need the missing V4 - V6