r/ECG

Hey everyone! This patient is a 67 YOM from a nursing facility presenting with Sepsis type symptoms (fever, AMS, tachycardia). 4L ECG looked sus so a 12L ECG was obtained showing what appears to be elevation in inferior leads with reciprocal depression in lateral leads. RBBB as well. I (with a degree of uncertainty) called a STEMI alert to the receiving facility. Cardiologist advised not a STEMI. What do you all see?

TLDR - I thought maybe STEMI. Smart heart doctor says no.

Woman with PMx of severe kidney failure, heart failure, ablation due to AF and been electrocardioverted x3 for afib/aflutter before. Now initially felt like she had atrial fibrillation for three hours before acute onset of central chest tightness.

I honestly have no idea what kind of rhythm this is. Have clear P-waves that seem dissociated from the QRS-complexes, but there are multiple identical PR-intervals. Is this some sort of conduction block?

Sats 62%, Coarse crackles globally.
Tachycardia sitting around 150 irregular.
Tachypnoea 40-50RPM
Burning sensation in chest.

I try searching for pseudo r waves in v1 for avnrt vs Frank spikes in the t wave or just outside qrs complex in v1 for avnrt in narrow complex regular rhythm tachycardias. But in this ecg for instance, i couldn't find either in the lead v1. So is it directly assumed that the p wave was too close to qrs and just fell into it?

Not my patient but my friend told me about this recent case. Good clinical case with good learning ECG.

4 yo, viral illness, fever, vomiting, skin almost grey, episodes of ALOC.

Two ECGs about 30 min apart.

Arrested once. Currently on ECMO.

Curious about what makes this a vfib, it has some Torsades looking traits

“It feels just like my regular heartburn, except for that it’s traveling down both of my arms.”

Thoughts on this ECG? Attended this guy a few days ago, bit of history:

65yom, overweight, smoker. Poor diet.

3 day history of intermittent tight central chest pain, it had been worse overnight, radiating to left upper arm and jaw but didn't tell anyone til the morning and then 999 was called. Reports 2/10 pain when we were assessing him. He also had an expiratory wheeze (we were thinking undiagnosed COPD).

This is the second ECG, post paracetamol, aspirin and GTN. His first showed a little depression in limb lead ii and peaked t waves in v2,v3,v4,v5. We took to local ED. I'm no ECG expert but I had bad vibes about it, particularly with the changes in v2, v3, v4, v5 and with all his history.

Edit to add - patient hasn't attended his GP in years, takes no meds and has no known medical hx

76YOM that presented with SOB upon exertion. Pt was given 5 stents.

Pt passed away at home not long ago after sudden onset of dysponea. Suspected renal failure/cardiac arrest.

Hi guys! I’m still a student and I do not have a single clue about what this could be.

Any help is appreciated!

Thanks :)

Here is a cool case a saw last week.
27yo male with intermittent palpitations for the last month or so. No PMH. Normal vitals. Normal exam.

83YoM with abdominal pain and GI complaints.

Confusing ECG, fast, irregular with what appears to be several P waves and morphologies per complex.

Young male 31 yo, active chest pain, strong family hx, troponin 4900 --> 7700. Initially I thought ECG didn't show ischaemia, leaning towards myocarditis, given recent viral symptoms. Admitted under cardiology. TTE.showed hypokinetic/akinetic inferoseptal and basal inferior segments. I was surprised to find out he had not had coronary angiography 24 hrs after the initial presentation.

Any features on the ECG suggesting MI? Patterns of STEMI equivalent? I will follow up again and see what angio shows eventually.

ECG ordered by ICU team to check QTc. Pt is 56 yo male, hx cardiac arrest d/t hypoxia, currently intubated with ARDs. I initially called the physician to notify of TWI and my concern for ?Wellens in the setting of critical care. Pulmonary physician said it looked okay to him, did not think it needed to be read by a cardiologist. Was I way off base here?

So how do I differentiate between atrial flutter and fibrillation? Do I go by RR regular/irregular intervals? Sometimes the difference between the P wave isn't really clear so it's hard to differentiate only by that ig.