Tuesday, September 7, 2010

12-Lead ECG: What Is It?

While cleaning up my office to put in a reading chair, I found the following 12-Lead ECGs from my clinical time.  I apologize for the poor quality of the first one, but it is a copy of a copy (of probably a copy). I have limited information on the patients for each of them somewhere in my clinical binder, but I haven't found those yet.


What do these two 12-Leads show?

Do you agree with the computerized statements?

Update on ECG 1 (16 Sept 2010)

The patient's lab values include a K+ of 2.1 mEq/L. What are some of the expected ECG changes in hypokalemia? Does this ECG show a classical or atypical presentation of hypokalemia?


Adam Thompson, EMT-P said...

I'll take a try.

First one is tough to determine. Can't tell the width, but data on it shows QRS duration less than 120 ms. Bradycardic rate. Some kind of atrial activity, most visible in V2. I would say that there appears to be complete AV disassociation. The Contracting rhythm is probably junctional if it is as narrow as it says. I think that this person probably underwent a severe cardiac event, ie. MI. T-wave inversion and Q-waves indicate injury pattern. If it is wide, as I initially thought, than it is idioventricular.

The second strip appears to be NSR with WPW and subsequent left atrial enlargement.

Quick interpretations, I am sure after I look at them some more I will find out what I missed.

Christopher said...

I guess I don't see the delta wave in the second 12L, what makes you think WPW?

I was thinking maybe LGL. Although, it could be WPW with concealed conduction.

burned-out medic said...

#1 looks like complete heart block with a higher/junctional escape focus.

#2 has p-mitrale in II and biphasic p in v1 - probably left atrial enlargement.

Hillis said...

First ECG i think shows bradyflutter ( the saw like projection in the precordial V1-2) , left axis deviation and incomplete LBBB - Does the patient had a pulsee !! actually am thinking about electrical -mechanical dissosiation a type of pulseless electrical activity.

The second ECG -is sinus rythm , the P wave is wider than normal and bifid , may be due to left atrial hypertrophy.The PR interval is shorter- Accessory pathway !!
Very interesting and shows the importance of clinical presentation and history.

Anonymous said...

These are nice strips.

#1 - could be sinus tach or atrial tach, rate could be between 120-130's, 4:1 AV block, inferoposteror MI, the El-shreriff sign (V5) could be ventrular aneurysm.

#2 - Sinut tach with LAA