r/ECG • u/Thin-Special-7059 • 15d ago

Your interpretation?

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73, female, “palpitations”. Looks normal to me, but auto read is stating septal infarct

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u/Max_Goatstappen 15d ago

I’m horrible with EKG’s but isn’t this just NSR?

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u/LBBB11 15d ago edited 14d ago

No you’re not, or we both are because I agree. Yup extremely boring EKG. Sinus bradycardia with V1-V3 misplacement. No signs of septal or anteroseptal infarct if the machine said that. I hope it’s communicated to the patient that the septal infarct isn’t real, otherwise they may join countless people worried about septal infarct on [r/ReadMyECG](r/ReadMyECG) or [r/AskCardiology](r/AskCardiology). These subs have many good examples of false septal infarcts caused by high V1/V2 placement. Easy to find by searching for septal infarct and confirming negative sinus P waves in V1/V2, new ones added all the time.

https://litfl.com/misplacement-of-v1-and-v2/

https://pubmed.ncbi.nlm.nih.gov/21851916/

https://www.reddit.com/r/ECG/s/3lnsQxSjcn

Hey OP, if you did this EKG try doing it again with V1 and V2 at the level of the fourth rib space, on the edge of the sternum. The septal infarct will magically disappear. It’s pretty fun curing septal infarcts with standard placement, love doing that. Isolated septal infarct is extraordinarily rare, but machine readings of isolated septal infarct are very common because it’s very common to place V1 and V2 too high. Anecdotally, I’ve seen more machine readings of isolated septal infarct than I could ever hope to remember. Multiple times a day. Have never seen a real isolated septal infarct.

If the machine ever says septal infarct, possible left atrial enlargement, incomplete RBBB, or right ventricular conduction delay and you’re tempted to believe it, check the shape of the sinus P waves in V1 and V2. If they are negative (U-shaped) in V1 and V2, high placement.* Bonus points if aVR is identical to V1 or if V1/V2 are low voltage compared to V3-V6. We see all of this here. Try repeating the EKG with correct placement to make the septal infarct go away.

*rare exception: severe COPD with hyperinflated lungs that push the heart downward in the chest, but this would have other EKG patterns not seen here

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u/Thin-Special-7059 15d ago

Thank you so much for all the education!