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

Whoops I didn't even notice the missing leads!

ecg_12lead022.gif
 
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. no ventricular hypertrophy.
7 Q in III, aVF, V1 V2, V3, V4 and V5. 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. Also light depression in V4 and V5. Flat T in V1.


Well... No ST elevation, but there is ischemia. also right axis deviation. Mi stage III anterior and posterior??? Difficult one...
 
ecg_12lead-leftanteriorfascicularbl.gif




dutch-emt said:
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.
Click to expand...
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winner winner!!!!
 
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Because it's getting quiet here, should i post a new EKG?
Yeah! why not....
Here is a new one!!

Is there a problem, and what is the problem?

34379911.jpg
 
MrBrown said:
My understanding is that it was right atrial enlargement.
Click to expand...

Right Atrial enlargement, that is all I saw, but I thought i was wrong until you said it.


P waves >= 3mv
 
Dutch-EMT said:
Because it's getting quiet here, should i post a new EKG?
Yeah! why not....
Here is a new one!!

Is there a problem, and what is the problem?
Click to expand...

Rate: 71 (1500 method)
Regularity: Regular
Rhythm: Sinus rhythm
P: Sinus P waves only
QRS: RS complex, ? Q waves in lead I only, ? something is seriously wrong with aVF looks like a block of some sort
ST: The ST segments in the chest leads dont look normal
PR Interval: 0.16 sec
QTc: Couldn't figure it out

There is something weird going on here.

This wasn't captured in Los Angeles was it? :D
 
Dutch-EMT said:
Okay, ECG number 3: A young male, 26years...
Any problems on this one?

34379905.jpg
Click to expand...

This is a strange coincidence!

I actually captured this 12-lead ECG. This is a great example of why it's important to interpret an ECG in light of the history and clinical presentation.

Normally the straight ST-segments in leads V2 and V3 with the slight terminal T-wave inversion in lead V2 would give me cause for concern.

But, since this was a totally asymptomatic firefighter lying on the kitchen counter in the fire station, I wasn't too concerned about it! :)

Tom
 
I wish I was Roy, but I have to admit being Johnny! LOL! :)
 
Johnny is better looking, and now, back to our regularly scheduled discussion
 
MrBrown said:
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

ecg_12lead022z.gif
Click to expand...

Right atrial enlargement, right axis deviation, low voltage, terminal R-waves in leads V1 and V2, and Q-waves in the right precordial leads. I would say pulmonary disease pattern (at a minimum).

Tom
 
Dutch-EMT said:
Because it's getting quiet here, should i post a new EKG?
Yeah! why not....
Here is a new one!!

Is there a problem, and what is the problem?

34379911.jpg
Click to expand...

It's always a mistake to interpret an ECG like this without the history and clinical presentation, but assuming (for the sake of discussion) that this is a chest pain patient with a suggestive history, I always get nervous when I see ST-depression and/or T-wave inversion in leads III and aVF, particularly if there appears to be reciprocal activity between III and aVL.

Tom
 
Dutch-EMT said:
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)
34379905.jpg
Click to expand...



Did anyone else notice the indicators of ventricular hypertrophy on this 12 lead? does this particular patient have a history of hypertension? or is it possibly that he has undiagnosed hypertension?
 
FLEMTP said:
Did anyone else notice the indicators of ventricular hypertrophy on this 12 lead? does this particular patient have a history of hypertension? or is it possibly that he has undiagnosed hypertension?
Click to expand...

It wasn't even a patient. It was a firefighter in perfect health. What criteria are you using?

Tom
 
Hypertrophy??? I don't see it.
Hypertrophy is a pathology of the heart.
A sportive young person with a bigger heartmuscle doesn't have a pathology of the heart?
When hypertrophy is suspected, a heartecho must be made to confirm a hypertrophy.
 
Assuming it was a symptomatic patient, when the QRSs of the precordial leads touch that is a quick and dirty look for LVH. Or you can do that whole count boxes max V1 or V2 plus max V5 or V6 with a sum> I think 35.

Also that last one, the possible inferior wall, seems to have some slurring of the QRS, almost looks like a delta wave. Might have an abnormal pathway, concern for WPW if it were going faster.
 
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TomB said:
It's always a mistake to interpret an ECG like this without the history and clinical presentation, but assuming (for the sake of discussion) that this is a chest pain patient with a suggestive history, I always get nervous when I see ST-depression and/or T-wave inversion in leads III and aVF, particularly if there appears to be reciprocal activity between III and aVL.

Tom
Click to expand...

Anyone else appreciate a delta wave? Looks a bit WPW to me.
 
now that you mention it... that hadn't even occurred to me
 
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