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

[tah06090]

 

[TomB]

Bad, bad, bad.

Undetermined rhythm. Tachycardia. Low voltage. Possible long QT-interval. Q-waves in II, III, aVF, and V1-V3.

Impossible to interpret without context. In other words, in light of the history and clinical presentation.

Could be anything from a massive heart attack to a pericardial effusion or cardiac tamponade (although electrical alternans is not present).

If I were a betting man I'd say this patient is sick!

Tom

 

[tah06090]

Elderly male chest pain Hx of inferior infarct and anterior infarct. dont know vitals all the info i know

 

[tah06090]

I work in a cardiology dept at a community hospital so i come across some pretty cool EKGs so i dont always know Hx or clinical presentation i have some more pretty interesting ones ill be posting soon.

 

[clibb]

Third degree heart block?

 

[Shishkabob]

I don't see any P-waves, and only one wide QRS


It seems junctional more than anything... junctional tachycardia?

 

[tah06090]

Doc called it sinus tach with extensive old injury which is altering qrs ie low voltage

I can post another one maybe a little easier if you guys want

 

[zmedic]

I don't see any P-waves, and only one wide QRS


It seems junctional more than anything... junctional tachycardia?

QRS isn't wide. Look at V5 and V6, narrow complexes. Don't get confused by those 3 PVCs.

Also since you have these huge, wide T waves it's quite possible that there are Ps buried in there.

 

[tah06090]

Elderly Female severe shortness of breath Hx of COPD, Diabetis any other things you wanna know ask

 

[truetiger]

How do her lungs sound? If clear, I would say she's having an MI. EKG shows an anterior hemiblock and her diabetes could be masking any chest pain.

 

[Shishkabob]

QRS isn't wide. Look at V5 and V6, narrow complexes. Don't get confused by those 3 PVCs.

Was that aimed at me or the guy who said it was a 3rd degree block?


If me, then no, because junctional tachycardia tends to be narrow, not wide, so I don't see why you mentioning that they are narrow is 'proving me wrong'?

 

[Simusid]

Elderly Female severe shortness of breath Hx of COPD, Diabetis any other things you wanna know ask

As a basic, I should be barred from participating in 12 lead discussions but as long as I'm here.... Do I see ventricular pacing spikes in V2-4? And if so, does that even matter? I think I see left axis deviation (lead I +, aVF -) and possible BBB but I can't tell left from right (yet).

 

[Shishkabob]

No, no pacer spikes.

 

[Simusid]

No, no pacer spikes.

Argh, of course not. If they were then the rate would be regular and it's clearly not. You do see the spikes I'm talking about Linuss? What are they?

 

[TomB]

Irregular and slightly polymorphic wide complex tachycardia with LBBB morphology. Probably AF. But do you trust that dx enough to give a CCB? I don't! Shortest R-R interval > 6 small blocks, so not so much worried about WPW but there are recorded cases of irregular VT. With no old ECG for comparison, I would leave it alone or give a drug like amiodarone that works on both supraventricular and ventricular arrhythmias. Very cool case and an excellent example of the real-world type of 12-lead ECG that can throw even experienced paramedics for a loop!

Tom

 

[tah06090]

Pt admitted for COPD exacerbation interpretation according to cardiologist is rapid afib with LBBB fast rate was because of respiratory distress and pts old ECGs showed LBBB with afib ill post another one maybe tommorow or saturday

 

[TomB]

Thanks for making that point, tah06090. I didn't mean to imply this specific patient should receive any antiarrhythmic. You always treat the underlying cause of a tachycardia (Hs and Ts) first.

Tom

 

[tah06090]

I understand what you meant its a hard 12 lead to fully interprt without looking at the pt right in front of you.

 

[zmedic]

Was that aimed at me or the guy who said it was a 3rd degree block?


If me, then no, because junctional tachycardia tends to be narrow, not wide, so I don't see why you mentioning that they are narrow is 'proving me wrong'?

Must have read it too fast, thought you were saying the QRSs were wide. That's what I was commenting on. Not saying that junctional would be wide.

 

[tah06090]

This one might be to easy ill heres soomething for a time filler till i find a HARD one 57yr old male sudden onset CP and dyspnea no Hx no old ECG