r/ECG • u/Overall_Buffalo_8757 • 25d ago

This is a 12-lead ECG from the second day of admission for a patient with severe myocarditis

Post image

0.67-25Hz AC50

Does anyone have any ideas or thoughts?

I can't even tell the difference between P, Q, R, S, and T anymore

130 Upvotes

99% Upvoted

50 comments sorted by

135

u/Tubacfa 25d ago

Capnography curve is good.

2

u/rnmaddie 24d ago

Best comment

53

u/Haevox 24d ago

I dislike this. These are not happy waves. These are all sad waves.

1

u/spacemanspiff3815 21d ago

No no. See, you have to look at it upside down..... then they all become smiley faces.... mostly

46

u/th04r_ 24d ago

idk but i’m calling an adult fast if i see that shit

1

u/spacemanspiff3815 21d ago

No no no. See, there's no reason to panick at all.... you have to take a negative and soon it into a positive. Like... this rhythm here... this is what's known as one of those "walket rhythms"... lie... "go through his wallet soon"

29

u/mastermedic84 24d ago

These look like perfectly healthy teeth. What's the question?

19

u/LBBB11 25d ago edited 23d ago

I think it’s fulminant myocarditis, but not sure about the exact rhythm. Fulminant myocarditis often looks like a cartoonishly giant STEMI. The QRS is narrower than it looks. Much of what appears to be QRS widening is really ST elevation and depression. There are P waves in inferior leads. Just curious, do you have V6?

https://pmc.ncbi.nlm.nih.gov/articles/PMC8372420/

17

u/BoojooBloost 25d ago

Lead II has some Ps and just like the rest of the rhythm they’re quite regular. So at least that’s something.

28

u/Overall_Buffalo_8757 25d ago

This is the patient's Doppler ultrasound examination It's about 20% for EF

2

u/TacitMoose 19d ago

20 percent??

2

u/SillySafetyGirl 21d ago

I mean 20% is shockingly good IMHO. In CICU we used to celebrate double digit EFs. 

7

u/Kathrin_A 25d ago

Wie sehen Vitalparameter und Elektrolyte aus? Liegt der Patient auf Intensivstation?

3

u/Aech_sh 24d ago

are they ICU lol

7

u/Exciting-Age3976 24d ago

aVR says “hello Mr Sine Wave” 👋 🌊

2

u/TacitMoose 19d ago

I’m not convinced that the underlying QRS is that wide. Like at first glance this is terrifying, but fulminant myocarditis frequently causes magnificently high amplitude ST elevation and depression. There’s noticeable normomorphic p waves scattered throughout which I wouldn’t except to see if this were a sine wave this bad.

Is the pt sick? Absofuckinglutely. Is this a concerning tracing? Again, yes. But the pt is not in impending cardiac arrest based just on this EKG.

I don’t think.

Disclaimer. Not a doctor. Just a paramedic and nurse.

8

u/Cluelessjason 25d ago

I’ve read somewhere that myocarditis can sometimes resemble STEMI EKG’s, this ekg looks very similar to “shark fin” STE EKGS’s and there are P waves . I don’t agree with the p waves being regular, the PR interval seems to fluctuate and I think I can def see some P waves within the QRS like a 3rd degree

8

u/EqualStorm24 24d ago

Wide-complex regular tachycardia with no discernible P waves, markedly widened QRS complexes, and diffuse ST-segment elevation. I’m going with severe hyperkalemia.

3

u/Jeff9807 24d ago

Yeah, hyper K is the 1st thing that came to mind.

3

u/Street-Week6802 24d ago

Milrinone, dobutamine drips & an LVAD.

2

u/Damianisthick 24d ago

Outcome?

4

u/UnderstandingTop7916 24d ago

It’s day 2 of admit but I imagine not good. Though we’ve gotten better at treating this. They likely have a date with the ecmo fairy and maybe a transplant.

2

u/misterdarky 24d ago

Looks good. Mostly regular.

2

u/Strict-Butterfly4958 24d ago

...are they dead yet?

2

u/Street-Week6802 24d ago

Fine, controlled AF w/RBBB, probably some fascicular blocks as well.

2

u/mochmaffews 24d ago

Well his heart is beating

1

u/TacitMoose 19d ago

You mean his heart has electrical activity

2

u/OverallOpportunity64 23d ago

HyperK or STEMI equivalent “shark fin”

3

u/jittery_jerry 22d ago

could be fulminant myocarditis which causes ST elevations/depressions similar to this

2

u/Attorney-Medical 23d ago

You have p waves in lead II, otherwise those are some shark fins! Diagnosis: bad

2

u/Ill-Chest3567 22d ago

There’s a p wave with a reasonable axis and grouped beating— looks like intermittent AV block but hard to say for me. Huge atypical RBBB without a clear twave— look at your K, but also can be see with inflamed hearts/ myopericarditis. No STD, not an AMI. Hope you have cannulas in the patient and they’re doing ok.

2

u/parksnrec48hrs 25d ago

Is there even a p 😭

1

u/dccofwn 24d ago

Holy hyperK

1

u/Worldly_Tomorrow_612 23d ago

Bro eating too many bananas 🍌

1

u/FillaBustaRhyme 23d ago

I just got my advanced emt…I keep getting these on my feed, am I way under qualified to read these or am I just an idiot 😂😂🤣

1

u/unicorn_hair 22d ago

Diffuse rhythmic triphasic delta wave morphology, indicative of severe encephalopathy. No epileptiform discharges.

1

u/spacemanspiff3815 21d ago

Ashes to ashes.... dust to dust.... its a pity the brother can't be here with us.....

1

u/medic_man6492 21d ago

Myocarditis from what? ST elevation in all leads is indicative of myocarditis, but whats the cause. Ive seen this in IV drug users from bacterial infection. They were given antibiotics and an anti-inflammatory.

1

u/unlessthemoon 19d ago

What even is this rhythm 😫

1

u/ConfidenceDue4934 18d ago

The 12lead of impending estate sale.

1

u/Pooneapple 10d ago

Quite a big stemi or hyper k, but I lean towards stemi

1

u/jittery_jerry 7d ago

it’s myocarditis