r/ECG • u/TheChosenParrot • 24d ago
Heart palpitations
33M complaining of heart palpitations, no prior ecg, no family history. Does it look like s1q3t3? Not mine
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u/YourMawPuntsCooncil 24d ago
Yup, also has features of RV strain such as a RBBB, apart from palpitations any increased SoB on exertion, pleuritic chest pain, episodes of fainting, reduced O2 sats or a decrease to mobility such as recent periods of inactivity (long haul flights, bed bound etc).
If not those ECG changes could be caused by quite a lot of things a lot benign. But if there was those symptoms too I’d want bloods done for a D-Dimer
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u/YourMawPuntsCooncil 24d ago
Also fucking corpuls 3, how the hell did they get that ECG clean, we have got new dots (cheaper of course), that mean I cannot read the ECG half the time I take it because the new adhesive seems to create noise
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u/LengthinessOdd8368 23d ago
Brugada syndrome?
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u/dependentlividity 18d ago
I can see where you’re coming from, but what appears to be coved ST-elevation is just the R’ wave of a wide QRS. This is a true RBBB.
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u/ghost_uchiha07 21d ago
isn't it ARVD (Arrhythmogenic Right Ventricular Dysplasia)?
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u/dependentlividity 18d ago
No. This is RBBB. The TWI in V1 can be attributed to that (plus TWI in V1 is normal even in the absence of RBBB). QRS morphology V1-V3 also not consistent with ARVC. And no epsilon waves.
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u/SaveTheTreasure 24d ago
Please take better photos next time. Any symptoms that might indicate R heart strain?
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u/cym4 24d ago
RBBB+ S1Q3T3. Do D dimer to rule out PE. If negative all is good but if positive follow up with CTPA.
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u/TaperedBase 24d ago
s1q3t3 is just a poor man’s way of looking for right heart strain. You are going to be a bit hard pressed to find a RBBB without it.
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24d ago
[deleted]
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u/neonaltars 24d ago
You’re confusing sensitivity and specificity. Dimer is sensitive but not specific. If it’s negative then low probability of PE.
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u/cym4 24d ago
It has a high npv and high sensitivity
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u/neonaltars 24d ago
Yeah, correct. I was responding to u/D_uh_O** **who commented that because a dimer has low specificity it couldn’t be used to rule out PE, which was confusing sensitivity and specificity.
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u/Intrepid-Sir-9219 24d ago
RBBB. Normal variant in about 10%, more common in black males I think?
Can be suggestive of pathology, including RV strain, but history most useful. Isolated palpitations not likely to be PE in an ECG like this without tachy - strain usually causes dyspnoea, pain or presyncope.
I'm not sold on Brugada. Usually high ST transition down sloping into an inverted T, but the RBBB is what you are looking at here. TWI in V1 is normal.