Alright smart people, name that EKG

Hockey

Hockey

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I want to hear everything you know about it


LPw4l.jpg


What do we have, any pr qrts r-r qt info


Would like to see what you think
 
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Sinus rhythm, running from around 60-75 bpm based on the 300 method, suspected hyperkalemia based on the large, peaked T-waves. I don't see anything clinically significant past that. Perhaps the variance in rate is benign, and correlates to respirations.
 
Well I see 5 consecutive 6 second strips. I am not familiar with a monitor that shows a second smaller waveform just above the main strip or the letter N above it. Perhaps you can enlighten me on this. Consistently I see 6 beats for every 6 seconds so a rate of 60. I see a P for every QRS and a QRS for every T. A bit hard for my eyes to make out but it appears each QRS is between .08 & .12 sec. long so as to be normal. The Ts are wide, tall and somewhat peaked so a possibility of hyperkalemia. There is 1 mm of st elevation quite consistently throughout. The base rhythm is sinus.
 
Sinus rhythm. The bottom lead is V2 and the S-wave is cut off so we don't know how deep it is. If the S-wave is very deep then a secondary ST/T abnormality in the opposite direction would not be unexpected. Blinded to this information (along with the history and clinical presentation) we can't call it abnormal. Could be LVH. Could be BER. Could be LAD occlusion. I don't think it's hyperK because there is no late take-off of the T-wave. These T-waves are broad based and asymmetrical.
 
Oliver.
 
Show me a 12 lead, otherwise I don't think it's super useful to try to diagnose a 2 lead for anything other than rhythm.
 
zmedic said:
Show me a 12 lead, otherwise I don't think it's super useful to try to diagnose a 2 lead for anything other than rhythm.
Click to expand...

No 12 lead available.

Just a few things I wasn't sure about
 
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TomB said:
Sinus rhythm. The bottom lead is V2 and the S-wave is cut off so we don't know how deep it is. If the S-wave is very deep then a secondary ST/T abnormality in the opposite direction would not be unexpected. Blinded to this information (along with the history and clinical presentation) we can't call it abnormal. Could be LVH. Could be BER. Could be LAD occlusion. I don't think it's hyperK because there is no late take-off of the T-wave. These T-waves are broad based and asymmetrical.
Click to expand...

What's BER, if you don't mind me asking? I'd guess benign early repolarization, which would explain the clinicaly non significant STE, which is also in monitor mode, not diagnostic. On the old LP12, I've seen STE's in II, III, and aVF, which weren't showing when I switched to diagnostic.

And, when are you going to publish a 12 lead book? I've shown your site to quite a few people on the job.
 
Yes, benign early repolarization. A book? I don't know. I used to think I didn't have the patience for it but if you added up all my blog posts you could probably make a book out of it! How about a smartphone app?
 
Thanks for the encouragement guys! Maybe I will.
 
Right ventricular Smith twitters with junctional mid-stem atrial frustration beats.
 
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