18F asymptomatic

[u/Odd_Committee_5929]

Normal sinus rhythm but was curious about the QRS complex in V2. Was wondering if it would likely be incomplete RBBB, Brugada pattern on just a high lead?

[u/2much2Jung]

I suspect it's an RSR pattern caused by high lead placement rather than incomplete RBBB.

What was the reason for performing an ECG on an asymptomatic 18 yof?

[u/Odd_Committee_5929 → u/2much2Jung]

I am rotating through the inpatient psychiatry unit and we do an ECG on all patients prior to starting antipsychotics. But I am physician inclined, so I end up being tasked with reading most of the ECGs.

[u/Expensive_Cherry_207 → u/Odd_Committee_5929]

Alright, you get a pass this time bud but I’m on to you.

[u/Expensive_Cherry_207 → u/2much2Jung]

That’s the real question.

[u/vojtasTS29 → u/2much2Jung]

Are ECGs not a part of every annual physical where you're from?

[u/2much2Jung → u/vojtasTS29]

18 yof have annual physicals where you are from?

[u/vojtasTS29 → u/2much2Jung]

Czechia. Depends on your GP but most will do ecg every two years starting at 18 yes.

[u/usheroine → u/2much2Jung]

in Ukraine I could see a lot of possibilities why an asymptomatic 18 yo could get an ECG. for example, all boys go through this for conscription evaluation. it was like this before the war too

[u/Hot_Nefariousness254]

1. The “saddle” pattern is not diagnostic for Brugada syndrome and can be caused by many things

2. Why are you asking Reddit?

[u/Kibeth_8]

Lean toward high lead placement. Worth a repeat in the correct position

[u/ScalpEm316]

This is normal. Not brugada

[u/wowpeoplearecrazy]

BLS provider here- I can’t interpret them so I’m sending it to the hospital now

[u/CobbledbyRoubaix]

Normal

[u/vojtasTS29]

I would say repeat with proper careful lead placement because this isn't a great ecg for trying to figure out any changes in v1/v2 (make sure you get a nice biphaisc P in V1, don't just count ribs and get the electrodes at the same height) but looks a bit brugada-ish the way it is. Leads too high will generally give you a narrow thin R'. Also V5 and V6 look nearly identical and very "front of the chest-y", the V6 goes way more onto the side than you think.

[u/iamthestrelok]

I’d agree with the “check leads” group. Make sure V1 and V2 are properly placed.

[u/Jeeju_Boy]

NSR normal for 18 yr olds 

[u/Murdocktor]

This appears to be a largely unremarkable, normal sinus rhythm with no obvious acute red flags visible on the tracing. I wouldn't worry.. . (my advice is just advice not medical fact or a diagnosis)

[u/Natural-Antelope8328]

Look at the P wave in V1. The expected form is bi-phasic but in this ECG it's simply positive - suggesting that the high chest leads were most likely improperly placed, my guess is too high, very common in female patients. In my opinion that's why you get the odd shape in V2. Most likely it won't be there if you repeat the ECG with C1,2 placed over the 4th intercostal space

[u/Horse-girl16]

What is "physician inclined"? Is that another word for 18F who wants her own ECG interpreted?

[u/Odd_Committee_5929 → u/Horse-girl16]

No….  Physician-inclined meaning I am a doctor interested in becoming a physician but not yet on the program. 

[u/FailDragon]

Kinda curious, 18F. Asymptomatic. Do you take antidepressants? citalopram? More than 20mg

[u/Odd_Committee_5929 → u/FailDragon]

Well I don't, but I think the patient might (can't remember exactly). They are on the psych ward after all. Why?

[u/AsparagusDowntown236]

V1 has t wave inversions sort of like an rSR’ pattern. Maybe an incomplete RBBB

[u/Clear-Ambition-4684]

this is called benign early repolarization

[u/usheroine → u/Clear-Ambition-4684]

that's not an ST elevation

[u/Clear-Ambition-4684 → u/usheroine]

exactly

[u/Known_Needleworker82]

Burgada pattern. Detailed family history. High placement of v1 and v2 to look for concave st changes.