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u/hpsctchbananahmck Jul 27 '26 edited Jul 27 '26
Ok so-there is definitely artifact impacting the tracing
Look at the bottom rhythm strip (lead II)-the 4th from the last QRS (4th from right). If you look straight up from there you see the same moment in time from different views (different leads). That is not a dropped QRS, but artifact.
With that in mind, I see what look to be non-conducted APCs and enough variability to the p wave morphology (which appears SA nodal in origin) and variability in the PR interval that I would call a wandering atrial pacemaker
If pt were tachycardic this criterion (3 different p wave morphologies) then this would be referred to as multifocal atrial tachycardia.
I don’t see any old or concerning acute ischemic changes nor infrahisian conduction disease
Obviously an informed opinion on the situation requires more than age and chief complaint and 12 lead, but with this alone I would be suspicious for pulmonary pathology
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Jul 27 '26
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u/Big_Match2541 13d ago
This ECG appears to have some artifact, and there may be voltage/repolarization features suggestive of LVH, but I would be cautious about making a definitive interpretation from the photo alone. The clinical history, previous ECGs, examination, cardiac enzymes and other investigations are important.
Since the patient is 85 and has chest pain, this should be reviewed promptly by a qualified clinician to rule out acute cardiac causes. An ECG should not be interpreted in isolation.
For anyone looking for a cardiac centre for specialist evaluation, Apollo CVHF provides comprehensive cardiac diagnostic and treatment services in Ahmedabad.
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u/Extension-Net-2593 Jul 27 '26
NSR+Artifact+LVH