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Name that ECG: 66 year old female – Findings

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This is the conclusion to our Name that ECG case: 66 year old female, resolved chest pain.

66 year old female, resolved chest pain.

Name that ECG: 66 year old female

 

Rhythm:

  • Rate: atrial rate of ~55 bpm, ventricular rate of ~55 bpm
  • Regularity: regular
  • P-waves: sinus (upright in I and II), associated 1:1 with the QRS
  • PRi: 140 ms
  • QRS duration: 90 ms

Bonus points:

  • Axis: -45 degrees, left axis deviation, LAFB
  • Bundle Branches: normal conduction
  • QTc: normal (<1/2 R-R interval), 420 ms (Bazett's Formula)
  • ST/T-waves:
    • T-waves: flipped T-waves in aVL, biphasic V2-V5 consistent with Wellen's Syndrome
    • ST-elevation: none noted
    • ST-depression: none noted

Differentials:

  • Normal sinus rhythm in a patient with Wellen's Syndrome
    • Possible high-grade stenosis of the LAD with recent reperfusion

Notes:

  • Wellen's Syndrome should be regarded with the same importance as a STEMI during assessment and transport.
Posted by on December 24, 2012 • Filed under: ems-topics • Tagged: , , ,

Name that ECG: 66 year old female

7 comments

Welcome to another installment of Name that ECG! Remember, this is a cold read and your job is to interpret the ECG to its fullest.

66 year old female, resolved chest pain.

Name that ECG: 66 year old female

 

Rhythm:

  • Rate?
  • Regularity?
  • P-waves?
  • PR interval? Associated?
  • QRS width?

Bonus points:

  • Axis?
  • QTc?
  • ST/T-wave changes?

What are your differentials?

Posts which include any permutation of the phrase "treat the patient not the monitor" will be deleted and their author beaten with a LifePak 5.

Posted by on December 21, 2012 • Filed under: ems-topics • Tagged: , ,

Name that ECG: 51 year old male – Findings

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This is the conclusion to Name that ECG: 51 year old male.

51 year old male, palpitations.

Name that ECG: 51 year old male

 

Rhythm:

  • Rate: ventricular rate ~185 bpm, unknown atrial rate
  • Regularity: regular
  • P-waves: none appreciated
  • PRi: N/A
  • QRS duration: ~200 ms

Bonus points:

  • Axis: inferior, +90 degrees
  • Bundle Branches: V1-negative, wide-complex
  • QTc: not appreciable
  • ST/T-waves:
    • T-waves: appropriate discordance in all leads
    • ST-elevation: not readily interprettable
    • ST-depression: not readily interprettable

Differentials:

  • Ventricular tachycardia

Notes:

  • Subtle dissociation of the atria may be visible in the ST/T-waves in II and III.
  • It is unlikely that this rhythm is anything but ventricular tachycardia.
  • The ST-segments in aVL are arguably excessive, potentially indicating an ACS cause of this tachycardia.

 

Posted by on December 17, 2012 • Filed under: ems-topics • Tagged: , ,

Name that ECG: 51 year old male

9 comments

Welcome to another exciting installment of Name that ECG. Remember, your job is to interpret the ECG to its fullest; we'll leave the treatment for somebody else!

51 year old male, palpitations.

Name that ECG: 51 year old male

 

Rhythm:

  • Rate?
  • Regularity?
  • P-waves?
  • PR interval? Associated?
  • QRS width?

Bonus points:

  • Axis?
  • QTc?
  • ST/T-wave changes?

What are your differentials?

Posts which include any permutation of the phrase "treat the patient not the monitor" will be deleted and their author fed to trauma hungry EMT students.

Posted by on December 14, 2012 • Filed under: ems-topics • Tagged: , ,

Name that ECG: 88 year old male – Findings

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These are the findings for our Name that ECG case: 88 year old male, weakness.

Name that ECG: 88 year old male

(click for a marked up image)

 

Rhythm:

  • Rate:
    • Atrial rate of ~120 bpm, appreciated in V1-V3
    • Ventricular rate of 33 bpm
  • Regularity: regular atrial and ventricular activity
  • P-waves:
    • Appreciable in V1-V3, unknown if sinus but rate is consistent with sinus tachycardia
    • The P-waves may or may not be associated with the QRS complexes, if they are it is a 4:1 association
  • PRi: if associated, high-normal at 210 ms
  • QRS duration: possibly slightly prolonged at 120-130 ms (V3 and V6 are widest)

Bonus points:

  • Axis: -45 degrees, pathologic left axis deviation (down aVF, up I, down II), LAFB
  • QTc: normal (< 1/2 R-R), 351 ms (Bazett's)
  • Bundle Branches: V1-positive (qR), R in Lead I, RS in V6, IVCD
  • ST/T-waves:
    • T-waves: biphasic T-waves in II/aVF/V6, flipped T's in I/aVL/V3-V5,
    • ST-elevation: possible ST-E in V1-V3
    • ST-depression: possible ST-D in I

Differentials:

  • Sinus tachycardia or atrial tachycardia with:
    1. 4:1 2nd Degree AV Block and IVCD
    2. 3rd Degree AV Block with a junctional escape rhythm (IVCD)
    3. 3rd Degree AV Block with a ventricular escape rhythm

Notes:

  • A longer rhythm strip from V2 would better highlight the degree of AV block present
  • A septal MI may be the cause of our patient's heart block and condition
Posted by on December 10, 2012 • Filed under: ems-topics • Tagged: , , ,

Name that ECG: 88 year old male

12 comments

Today our goal is to interpret the ECG to its fullest from a "cold read" perspective. We're giving you the patient's age, chief complaint, and ECG…and that's it!

88 year old male, weakness.

Name that ECG: 88 year old male

Rhythm:

  • Rate?
  • Regularity?
  • P-waves?
  • PR interval? Associated?
  • QRS width?

Bonus points:

  • Axis?
  • QTc?
  • Bundle branches?
  • ST/T-wave changes?

What are your differentials?

Posts which include any permutation of the phrase "treat the patient not the monitor" will be deleted and their author will be reassigned to the unit that never gets off shift on time, you have been warned.

Posted by on December 6, 2012 • Filed under: ems-topics • Tagged: , ,