If You Can't Trust Your Doc,...EKG quickie

[GetMeOuttaThisMess]

Annual wellness exam. Getting old so occasional ectopic beat (isolated about every 6-8 weeks apart I'd guess) noted on pulse check w/o run of tachyarrhythmia over past couple of months. FH of AF with parents and younger brother. EKG done (this provider even does them if asx. for the $$$ only I suspect). Nurse comes in to tell me that it's ok and that we're done. "Uh, I don't think it was normal. There's a new LAD and LAHB but at least I know it's there now." Saw EKG on computer display and not on paper. For those who are new to the profession a quick EKG tip. If lead I is positive, lead AVF is negative, and lead II is negative then you've got yourself a LAD and a LAHB. Getting back to the visit, "I would like a Ca+ Index score to see how much Ca+ buildup you have at this point." My thought bubble says, "And the benefit of this is what to me? Pt. asx. aside from unsustained new onset ectopy. What are you going to recommend next; a cath for an asx. pt.? I don't think so." Time for a new PCP me thinks.

 

Someone please feel free to correct me if wrong but one of my old cardiologists passed this along in addition to both I and AVF being negative representing a RAD w/o having to do all the interpolation.

[PeteK777]

Not all axis deviations point to problems with the fascicles.. if you're gonna call it LAFB/LPFB, you gotta look at the QRS morphology in the lateral and inferior leads.

 

http://lifeinthefastlane.com/ecg-library/basics/left-anterior-fascicular-block/

 

http://lifeinthefastlane.com/ecg-library/basics/left-posterior-fascicular-block/

[GetMeOuttaThisMess]

If you think about the basic physiology of the current direction, and also go through the motions of interpolating the axis, I think one will find the above to be true, considering leads are correctly placed. Remember, it's a quick glance interpretation.

[rev ronin]

The quick tip I was taught is left thumb is I, right is AVF, so I up AVF down is LAD, I down AVF up is RAD and both down is extreme.

[sk732]

The quick tip I was taught is left thumb is I, right is AVF, so I up AVF down is LAD, I down AVF up is RAD and both down is extreme.

 

I was taught the same thing...get weird looks at work sometimes when people see me doing that.

[GetMeOuttaThisMess]

For grins I printed out the electrical axis diagram when I got to work this morning and my original way of looking at it is correct as well, and I don't need my thumbs, well except to hold a coffee mug. If you look at lead Il and it's negative you'll see it is pointed in the direction allowing for retrograde/delayed depolarization with a fascicular block.