BayPAC Posted September 14, 2019 Share Posted September 14, 2019 Link to comment Share on other sites More sharing options...
UGoLong Posted September 14, 2019 Share Posted September 14, 2019 I'd say normal, with perhaps some early repolarization vs some benign individual abnormality in lead III. How old is the patient and does he have any cardiac complaints? Just guessing, but I'm guessing that it's from a thin, relatively young person given the size of the R waves. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted September 14, 2019 Share Posted September 14, 2019 Depends on what your definition of "normal" is. Within normal limits? Yes. Unconcerning? Yes. Perfect? No. Link to comment Share on other sites More sharing options...
BayPAC Posted September 14, 2019 Author Share Posted September 14, 2019 39 y/o obese female, L arm pain radiating to neck/left ear Computer reading = ABNORMAL It seems normal to me Link to comment Share on other sites More sharing options...
PickleRick Posted September 14, 2019 Share Posted September 14, 2019 Hard to tell from the angle of the photo, so it could be just the way I'm seeing it. The P-wave appears to be a little notched. Usually suggests left atrial hypertrophy. I know a guy who is much better at this stuff than I am. Hopefully, he will be along shortly. Link to comment Share on other sites More sharing options...
bike mike Posted September 14, 2019 Share Posted September 14, 2019 No evidence of ischemia on this resting ECG. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 14, 2019 Moderator Share Posted September 14, 2019 Biphasic P wave in v1. NSR. No interval changes. Normal axis. No ST changes. No STEMI or equivalents. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 14, 2019 Share Posted September 14, 2019 28 minutes ago, LT_Oneal_PAC said: Biphasic P wave in v1. NSR. No interval changes. Normal axis. No ST changes. No STEMI or equivalents. How do you know that there isn't an interval change w/o a prior ECG to review? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 14, 2019 Share Posted September 14, 2019 (edited) Even though I've posted this before it might be new to someone else. If I and AVF are both positive you have a normal axis. If I is positive and AVL is negative you have a LAD. If lead II is then negative in this setting there is also a fascicular block. If I and AVF are both negative then you have a RAD. Don't forget to know what a normal QT interval is. I never looked at the machine interpretation until I had read it myself just because I didn't trust the machine. Edited September 14, 2019 by GetMeOuttaThisMess Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 14, 2019 Moderator Share Posted September 14, 2019 29 minutes ago, GetMeOuttaThisMess said: How do you know that there isn't an interval change w/o a prior ECG to review? Did it go from abnormal to normal then? The point is it’s not a change from normal Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 14, 2019 Share Posted September 14, 2019 1 hour ago, LT_Oneal_PAC said: Did it go from abnormal to normal then? The point is it’s not a change from normal My point was the assumption is that it is a baseline study w/o comparison. Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 14, 2019 Moderator Share Posted September 14, 2019 1 hour ago, GetMeOuttaThisMess said: My point was the assumption is that it is a baseline study w/o comparison. I know that. You’re just arguing semantics. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 14, 2019 Share Posted September 14, 2019 Disregard. Not worth arguing over. Link to comment Share on other sites More sharing options...
PickleRick Posted September 15, 2019 Share Posted September 15, 2019 3 hours ago, LT_Oneal_PAC said: You’re just arguing semantics. I disagree. In order to determine whether or not there has been an interval change, one would need to compare the current study to one done previously. An interval change has nothing to do with comparing it to a normal study. Someone could have a right bundle branch block on a current study and, if I pull one from six months ago, and it was there as well, then I can declare "No interval change." Without a baseline/prior ECG, one should not be making such a statement. 1 Link to comment Share on other sites More sharing options...
Arthropathy Posted September 15, 2019 Share Posted September 15, 2019 (edited) Um...I think they were referring to the QT interval. (Which I thought was a tad long) Edited September 15, 2019 by Arthropathy Pronouns Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 15, 2019 Moderator Share Posted September 15, 2019 1 hour ago, PickleRick said: I disagree. In order to determine whether or not there has been an interval change, one would need to compare the current study to one done previously. An interval change has nothing to do with comparing it to a normal study. Someone could have a right bundle branch block on a current study and, if I pull one from six months ago, and it was there as well, then I can declare "No interval change." Without a baseline/prior ECG, one should not be making such a statement. Given your example, I believe you are reading interval as “inbetween this time and last” when I mean there is no alteration of the PR, QT intervals from normal, not that the study is unchanged from prior. If that was the original point, then I apologize we had a miscommunication. 1 Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 15, 2019 Share Posted September 15, 2019 Given your example, I believe you are reading interval as “inbetween this time and last” when I mean there is no alteration of the PR, QT intervals from normal, not that the study is unchanged from prior. If that was the original point, then I apologize we had a miscommunication. This is what I meant as well. Last ECG compared to this one. Thanks Pickle (Dill, I hope). Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 15, 2019 Share Posted September 15, 2019 Slight sinus arrhythmia? That's the only thing I can see. Link to comment Share on other sites More sharing options...
Moderator ventana Posted September 15, 2019 Moderator Share Posted September 15, 2019 anyone else notice ? Q wave in III and poor Rwave progression remember that EKG does not rule out ACS inthat patient - female, obese, would need trop to rule out ACS 1 Link to comment Share on other sites More sharing options...
PickleRick Posted September 15, 2019 Share Posted September 15, 2019 12 hours ago, LT_Oneal_PAC said: ... I mean there is no alteration of the PR, QT intervals from normal... Gotcha. Thanks for your clarification. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 15, 2019 Share Posted September 15, 2019 46 minutes ago, ventana said: anyone else notice ? Q wave in III and poor Rwave progression remember that EKG does not rule out ACS inthat patient - female, obese, would need trop to rule out ACS Our EP advised the group that as long as R>S (PRWP) by V4 then we were ok in the absence of pathologic findings otherwise and we weren't concerned about ischemia. Link to comment Share on other sites More sharing options...
MedicinePower Posted September 16, 2019 Share Posted September 16, 2019 (edited) On 9/14/2019 at 12:39 PM, GetMeOuttaThisMess said: Even though I've posted this before it might be new to someone else. If I and AVF are both positive you have a normal axis. If I is positive and AVL is negative you have a LAD. If lead II is then negative in this setting there is also a fascicular block. If I and AVF are both negative then you have a RAD. Don't forget to know what a normal QT interval is. I never looked at the machine interpretation until I had read it myself just because I didn't trust the machine. By "have a LAD" do you mean in the presence of a STEMI in the anterior leads when I is positive and aVL is negative? I'd love for you to parse this out for me as I've never heard this. Edited September 16, 2019 by MedicinePower Link to comment Share on other sites More sharing options...
PickleRick Posted September 16, 2019 Share Posted September 16, 2019 5 hours ago, MedicinePower said: By "have a LAD" do you mean in the presence of a STEMI in the anterior leads when I is positive and aVL is negative? I'd love for you to parse this out for me as I've never heard this. LAD = Left Axis Deviation 1 Link to comment Share on other sites More sharing options...
surgblumm Posted September 16, 2019 Share Posted September 16, 2019 Of course, we need to hear the clinical presentation and this female presents with a cardiac complaint therefore we need to look at this EKG and also at whatever cardiac labs we are ordering to check for inconsistencies. I see a fairly normal EKG with NSR, No Ischemia, No depressions of the T wave , good progression and a r wave that seems high but this may be due to her heavy chest wall. Without any other signs or symptoms I probably would reassure her and have her return to the ER if these symptoms return or worsen and then be followed by cardiology. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 16, 2019 Share Posted September 16, 2019 8 hours ago, MedicinePower said: By "have a LAD" do you mean in the presence of a STEMI in the anterior leads when I is positive and aVL is negative? I'd love for you to parse this out for me as I've never heard this. We're talking a positive, or upright R wave, when assessing the axis as PickRick pointed out. You are taught the the correct way to determine the axis is to find the most equiphasic limb lead and then look at the lead 90 degrees to it and determine if it is positive or negative and that will give you the axis. This is just a quick shortcut. Link to comment Share on other sites More sharing options...
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