What this Ekg looks like?

H

HMartinho

Forum Lieutenant
Messages
121
Reaction score
2
Points
18
A 57 yo f, complaining of chest pain, dyspneia and palpitations.

P.S.: I was not on scene, so I did not a lot of details.
 

Attachments

  • IMG_20141003_200933.jpg
    IMG_20141003_200933.jpg
    591.3 KB · Views: 841
Not a great image, but I don't see any P waves in there and the QRS complexes look wide. I'd almost describe the 2nd beat as a PVC that's following a ventricular escape beat. Interesting! I hope others more learned in these ways than I am would chime in... In any event, I'm thinking PACE IT!!!!
 
If someone could include an explanation of their interpretation too, that would be awesome. All I have is that it is wide complex and has an atrial pacemaker that is sensory. And agreed that the 2nd beat is a PVC.
 
Seeing the whole 12Lead would be helpful. Hard to make an interpretation on a partial 12Lead sometimes.
 
One could argue a RBBB, too.

Need full 12 lead next time. That's just annoying to look at.
 
Looks like a accelerated junctional escape... The deep narrow Qwave says either this is septal hypertrophy / cardiomyopathy or a sudden onset non STEMI M.I, there is a demand pacer involved on this rhythm as well... Without assessing the pt myself its tough to be more direct... Only other possibility I can see would be a pt with WPW WHO IS DECLINING... assessment with Hx & Rx is everything!! My 2 cents
 
I'm wondering about hyperkalemia. Absent p waves, widened qrs, with tall sharp looking t waves. Check the potassium. That's just my two cents though.
 
That is a jacked up ekg. I know I wanted the whole 12-lead, but I want a strip like 12 seconds long, and I want the deets of the HPI and Hx including cardiac meds.

But if I had to guess I would agree with @NightShiftMedic that we are looking at a case of hyperkalemia (for the reasons he mentioned). Has this guy missed a dialysis or been mainlining bananas? Kidney failure? OP I know you weren't on this call but can you get any updates?
 
2 things:

1. This is Hyperkalemia until proven otherwise.
2. The filter settings would be very interesting to know as this ECG looks like it has monitor mode filtering enabled.
 
Bahaha mainlining bananas.

I agree with hyperK.
 
Late to the game, but this is hyperkalemia.
  • The QRS is wide, but V1 and V6 do not show clear LBBB or RBBB morphology.
  • Both the QRS downstroke and the upstroke are slow, consistent with hyperkalemia.
  • The T waves are "peaked," but more importantly they are narrow and symmetric.
    The sine-wave pattern suggests that the K is fairly high, 9ish.
What was the clinical context?
 
Looks almost exactly like a strip we had last night. It turned out to be hyperK when we checked in with the doc later in the night. HR was 23 when we arrived AAOx3 somehow. No radial pulses and could not get a BP. Once atropine and fluids were on board HR was bouncing around between 40-60, and the BP was 96/50. Pacing was the next step, but decided against it due to the circumstances. Also, did not move on to dopamine, cuz well, its dopamine.

Mind you this was the first call of the night for "back pain."
 
You must log in or register to reply here.
Back
Top