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

Dutch-EMT

Dutch-EMT

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A Dutch forum does this since a while, and it's actualy fun to do, but above all: It's always interesting to do and you can learn from eachother!!

I'll start with the post of an EKG. Everybody can interpretate on it here.
Who joins?

Okay here it is. The first:
ECG04a.jpg

ECG04b.jpg


Well, what do we got here?
 
i'm still learning ecg interpretation, but it looks like

normal axis sinus rhythm with a possible 1st degree av block and possible left bundle branch block with no st changes or ectopy at 90?
 
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ive seen that rythm before in lead II i posted up about it also. from reading its like a bundle branch block of some degree or previous m.i
coming from a basic point of view

btw keep this thread up its a great idea
 
emt_irl said:
ive seen that rythm before in lead II i posted up about it also. from reading its like a bundle branch block of some degree or previous m.i
coming from a basic point of view

btw keep this thread up its a great idea
Click to expand...

I don't see any previous MI myself. I see pathological left axis deviation, I don't really see a BBB, but a hemiblock is present. Also there may be some electrolyte abnormalties.

Lets remember that everyone can interpret these different.
 
I see NSR with 1st Deg AV Blk.
 
To me, there's no sign of an MI. There's no ST elevation or depression noted in any of the leads. Looks like a Sinus Rhythm w/ 1st degree av block. The QRS is to short for it to be a Bundle Branch Block. I eyeballed it, looked like 0.10 seconds
 
rhan101277 said:
Lets remember that everyone can interpret these different.
Click to expand...

That's true, but that doesn't mean they are all correct.

However, you are correct. This 12-lead ECG shows sinus rhythm with left anterior fascicular block.

Tom
 
10 points for TomB!

Conclusion:
P tops followed by a QRS complex, so it's a sinusrythm.
PQ-time, well what can we say about it?
Frequenty about 85bpm
Axis: I = mainly positive, aVF = positive, so it's a left axis deviation.

QRS: it seems wide, but is it BBB? No, let's look to the QRS in V1-V6.
The R-top progression seems slow in V1-V6. The S is deeper than normal in V6.
A lower intraventricular conduction (is it correct english?),the R wich doesn't show up very well, in combination with a left axis deviation and a deep S in V6...

Answer: Left anterior hemiblock or left anterior fascicular block!

Okay, next one!!!

34260674.jpg


For a bigger screen, click HERE
 
Tooo easy mate! NSR (1500 method says 60bpm so technically is sinus brady) with anterior MI; I picked one of those up the other week.

How come Lead II in the first strip is negative instead of positive?
 
Don't believe this is a STEMI. Looks like NSR w/left posterior hemiblock.
 
Okay, just a little information extra at this ECG:
male, 28 years, no history, no med's.
 
And no chief complaint?

At first glance it's acute anterior STEMI vs. benign early repolariation.

I would capture another ECG in 5 minutes and compare (assuming signs and symptoms of ACS).
 
The wandering baseline in leads I and aVL is unfortunate. It goes to show that even a minor problem with data quality can confound a nuanced interpretation. Looks like 1 mm ST-elevation may be present but I'd want a clean tracing.

The mean R-wave amplitude in leads V1-V4 is right at 5 mm, so Dr. Smith's decision rule is not decisive.

http://hqmeded-ecg.blogspot.com/2009/06/acute-anterior-stemi-from-lad-occlusion.html

Tom
 
1mm ST-elevation mostly isn't significant... mostly...
I personally never make a MI out of this when it's the only sign i've got...
 
At this EKG the R is very small in V1 and V2, and a deep S. But that's normal.
I have a standard procedure to look at EKG's, in hope to catch all information out of it.

1. Frequency
2. Rhytm: is it regullar or irregular
3. P's: yes/no, are they looking the same? P's followed correctly by a QRS?
4. PQ time (<0,2sec), QRS time, BBB?
5. Heartaxis: Look at I and aVF
6. Hypertrophy? P in V1 (atrial hypertrophy) and S in V1 and R in V5 >3,5mV (LVH). R in V1 and S in V5 >1,05mV (RVH)
7. MI? Q's, ST and T
 
Frequency

1. Frequency
2. Rhytm: is it regullar or irregular
3. P's: yes/no, are they looking the same? P's followed correctly by a QRS?
4. PQ time (<0,2sec), QRS time, BBB?
5. Heartaxis: Look at I and aVF
6. Hypertrophy? P in V1 (atrial hypertrophy) and S in V1 and R in V5 >3,5mV (LVH). R in V1 and S in V5 >1,05mV (RVH)
7. MI? Q's, ST and T


I am a medic in the U.S and I understand your list except for the 1st word... frequency. 2-7 are simular to what I learned, but what do you mean by Frequency?

Here is a great site for anyone that wants to work on their 12 lead's, I study here among other websites.
http://library.med.utah.edu/kw/ecg/index.html
 
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i think he means heart rate
 
Lol.

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.
ecg_12lead-leftanteriorfascicularbl.gif
 
The EKG I posted was a totally normal EKG.
It's made on myself by the cardiologist during a cardiologyclass.
 
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