veron Posted March 19, 2013 Share Posted March 19, 2013 hi, i'm a student and i've been trying to figure out this ecg but its just making me more confused.. the background is: elderly female presents with grade 3 pitting edema bilateral lower limbs sob on exertion electrolytes normal trop t elevated (21.4) NT-proBNP elevated (763) what i've got so far is: rate-90bpm rhythm-regular p wave - normal qrs - normal t wave - 'flatten' left axis deviation the "model" answer that i'm told is that its IHD with CCF. but i can't explain the deep s wave in II, III, aVF as well as the RSR' in V2 any assistance is greatly appreciated Link to comment Share on other sites More sharing options...
rcdavis Posted March 19, 2013 Share Posted March 19, 2013 Look up how to discern left anterior hemi-block ( fascicular) block.. There in might lay your answer . The rsr' IS the IRBBB incidentally, There is also a hint of p-mitrale ( now known as left atrial hypertrophy). Link to comment Share on other sites More sharing options...
Teasip Posted March 19, 2013 Share Posted March 19, 2013 Do you know the "short-cuts" to determine axis (without looking at the EKG machine printed values) and LAHB? Also look at your QTc interval (you can use the machine's value for this). While borderline for a female, it is something to also pay attention to. Link to comment Share on other sites More sharing options...
Teasip Posted March 21, 2013 Share Posted March 21, 2013 Since OP hasn't responsed I thought I'd post this for others in case they weren't aware. Normal axis if leads I and AVF are both upright (R>S). LAD if lead I is upright and AVF is downward. RAD if both are downward. With regard to LAHB; If LAD is present and lead II is downward then by default you have a LAHB. Link to comment Share on other sites More sharing options...
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