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

[TomB]

I don't think so. The PR-interval is borderline at 120 ms. The axis is normal at about 10 degrees. Normal septal Q-waves are present. Normal R-wave progression and transition. This all leans against pre-excitation.

Tom

 

[FLEMTP]

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.

yeah that! I didnt get a chance to answer back quick enough.. its been a busy shift at work!

 

[Dutch-EMT]

Should we go on with this one?
Anyone?

 

[rhan101277]

Should we go on with this one?
Anyone?

Physiologic left axis.

Looks like a normal ECG to me.

 

[Dutch-EMT]

1 Heartrate: ?
2 Rythm: ?
3 P ?
4 PQ ?. QRS ?
5 Axis: I:? aVF:?
6 Hypertrophy: P in V1?. ventricular hypertrophy?
7 Q? ST? T?

conclusion based on this EKG?

 

[rhan101277]

1 Heartrate: ?
2 Rythm: ?
3 P ?
4 PQ ?. QRS ?
5 Axis: I:? aVF:?
6 Hypertrophy: P in V1?. ventricular hypertrophy?
7 Q? ST? T?

conclusion based on this EKG?

2) Sinus Rhythm 90HR
3) P waves normal, upright etc.
4)PR interval and QRS normal
5) Physiologic left axis, no hypertrophy

There is some possible electrolyte abnormalties, but then again some people have inverted T waves normally in certain leads. Maybe some minor damage in aVF but it is not full thickness.

 

[Dutch-EMT]

1 Heartrate: about 75 bpm
2 Rythm: P waves followed by QRS. regular rhytm... sinus rhytm.
3 P: Some P's look different in the 10sec. print.
4 PQ is short. Delta-waves very good to see in II, V3-V6
QRS is <120msec. They look wider as usual. a very small spike after R in III, aVL, aVF. Also the R doesn't show up very well in V4-V5...
5 Axis: I: very positive, aVF: negative. left axis deviation.
6 Hypertrophy: no signs of it.
7 No pathological Q's. ST's not significant elevated or depressed. T negative in III and V1, flat in aVF.

I would say WPW with pre-excitation.

 

[FL_Medic]

I concur with WPW

 

[nmemtp01]

This patient is a 36YO female who present at a rural clinic complaining of palpitations and dizziness.

 

[clibb]

This patient is a 36YO female who present at a rural clinic complaining of palpitations and dizziness.

Any nicotine or caffeine intake prior to this? Lead one looks like SVT.
Lead two and looks like a V-Tach with a possible bundle branch block.
I'm just a EKG-Basic. So I only know 4-leads

 

[clibb]

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?

Is there some A-fib going on?

 

[nmemtp01]

The patient states that she has had these episodes for the last couple years, but her symptoms usually dissipate before she gets to an ER. Therefore, she doesn't have any diagnosed condition. Usually the onset starts with exercise, however, today it was while cleaning her house. The patient denies any other medical problems and allergies. Vitals are as follows:

BP: 110/80
HR: 240
Resp:16
SPO2 98%
LS: clear to ausc.
Skin: P,W,D
BLG: 88

 

[Dutch-EMT]

1 Heartrate: +/- 250bpm
2 Rythm: Chaos! it is regular...
3 P top: In V1 it seems to me that there is an AV-block.
There isn't any connection between the P and the complex following.
It seems like the P top comes together with the QRS in the last complex of V1
4 PQ/QRS QRS seems wide... In V2 R-R1? Loss of R wave and Q wave formation.
5 Axis: I: + aVF: - That means leftaxis deviation
6 Hypertrophy: P in V1. ventricular hypertrophy
7 Q in II, III, AVF, V3, V4, V5 and V6
Negative T in aVL, V1 and V2

The Q's in II, III and aVF are pointing to an inferior MI
The Q's in V3-V6 are pointing to an Anterior Lateral MI
High T also in II, III, avF.
Q waveformation and loss off R tells me the infarct must be at least a couple of hours old.

I believe this is an Inferior MI and Anterior Lateral MI.
Possibly this patiënt has an infarct in the left main coronair artery.
This is blocking the ramus circumflexus and the left anterior descending artery. In 20% the ramus circumflexus provides the inferior heartmuscle with blood. That's my guess...

 

[TomB]

I concur with WPW

If it was, the septal Q-waves in the high-lateral leads would be obliterated and the T-waves would be deflected opposite the delta waves.

 

[TomB]

This patient is a 36YO female who present at a rural clinic complaining of palpitations and dizziness.

Slightly irregular and polymorphic wide complex tachycardia with a very fast rate. Shortest R-R interval is < 6 small blocks which indicates a high probability of an accessory pathway.

Differential diagnosis:

1.) WPW (either atrial fibrillation or 1:1 atrial flutter)
2.) Ventricular tachycardia

Treatment:

Keep the drugs in the drug box! Unless, of course, you carry procainamide. The best course of action in the prehospital setting is supportive care and synchronized cardioversion if the patient becomes hemodynamically unstable.

Cool case!

 

[Dutch-EMT]

nmemtp01: What was the diagnosis?

 

[nmemtp01]

Although I do agree with Tom that monitoring and transport would be the idea treatment, that wasn't what was done. The patient was given 6 mg of Adenosine and converted into a NSR. As far as the diagnoses, I'm not 100% sure. I'm guessing a WPW, LGL, or some other aberrancy pathway. I'll try and get the official word from the cardiologist some time soon.

 

[TomB]

Although I do agree with Tom that monitoring and transport would be the idea treatment, that wasn't what was done. The patient was given 6 mg of Adenosine and converted into a NSR. As far as the diagnoses, I'm not 100% sure. I'm guessing a WPW, LGL, or some other aberrancy pathway. I'll try and get the official word from the cardiologist some time soon.

Since the adenosine worked there's a good chance it was AV reentrant tachycardia (AVRT) which is a circus loop tachycardia with antegrade conduction down the accessory pathway and retrograde conduction up the AV node. It's probably not the treating paramedic's fault. Accessory pathway-mediated heart rhythms aren't generally covered in paramedic school. I'm glad it worked out! I commend the treating paramedic for capturing a 12-lead ECG prior to treating with an antiarrhythmic.

**Addendum**

Just looked at the post-conversion 12-lead ECG. Again, well done by the treating paramedic. The absence of a WPW pattern is interesting. If it's a concealed conduction pathway, it would suggest an orthodromic AVRT with aberrancy as opposed to an antidromic AVRT. But why knows? Patients like this probably end up in the EP lab. If you find out anything definitive, let us know!

Really cool case! Thanks for sharing.

 

[clibb]

Although I do agree with Tom that monitoring and transport would be the idea treatment, that wasn't what was done. The patient was given 6 mg of Adenosine and converted into a NSR. As far as the diagnoses, I'm not 100% sure. I'm guessing a WPW, LGL, or some other aberrancy pathway. I'll try and get the official word from the cardiologist some time soon.

Lead II, some 1st degree heart block there?

 

[nmemtp01]

clibb, I would agree that it looks like a first degree block, or possibly even a wenckebach(hard to tell without seeing a couple more seconds) after the patient converted.