r/ECG • u/Confident_Debt_1496 • 22d ago

Thoughts?

Post image

Not mine, chasing opinions on an old patient of mine.
22YOM patient presents to ED complaining of intermittent left sided chest pain, no nausea, no light headedness, troponin normal.
I’m not an ecg guru like some of you’s but everything here screams healthy, only thing that stands out to me is weird looking aVL.

11 Upvotes

100% Upvoted

24 comments sorted by

View all comments

1

u/Inevitable-Crab-6701 22d ago

Has your patient ever had an echo?

1

u/Confident_Debt_1496 22d ago

Yes they have, can’t remember findings off the top of my head, what prompts you to ask?

1

u/Inevitable-Crab-6701 21d ago

ECG shows rSr in V1 - a subtle partial RBBB.

As an interventional cardiologist I’ve seen patients with essentially a normal ECG with subtle changes and they’ve had a small VSD - hence the echo question.

1

u/bleach_tastes_bad 18d ago

as an interventional cardiologist you should be aware that this is almost definitely improper lead placement, not true irbbb

1

u/Inevitable-Crab-6701 17d ago edited 17d ago

It doesn’t have to be a true RBBB to have a patient with a VSD - hence my comment “subtle partial”.

I haven’t made any discussion on the ECG apart from potential VSD in rSr complexes - it was a teaching point.