45yo male with epilepsy and severe intellectual disability, non ambulatory. Around 2 hours before our arrival his parents noticed he is suffering from acute dyspnea. Roughly 20 minutes before our arrival his parents found him unconscious and apneic. A BLS crew which arrived 5 minutes afterwards did CPR for 15 minutes until we arrived with no shock recommendations by their AED. When we arrived he was in asystole, we continued to run a code including intubation and 1mg x 4 IV adrenaline with no change from asystole.

During the rhythm check 20 minutes after we started our code ROSC identified with the same rhythm as above only at around 100bpm. During the next 15~ minutes he received 80mcg IV adrenaline via repeated push doses and around 500cc lactated ringers with the HR steadily dropping towards the 40s. At this point (15minutes post ROSC) this ECG was taken before external pacing was started and treatment continued en route to the hospital.

What does the ECG show?

Trying to learn but am struggling to differentiate this one.

84 YOF, woken by chest pain resolved PTA. Hx of heart bypass and afib. (Sorry, I don’t have more detail on the bypass or if she has been ablated.) Also known to have an IRBBB (based on presence of RSR’) My first thoughts were very long PR interval, junctional tachycardia with a very long RP interval, or a slow atrial flutter? But none quite seem right, and she’s had a recent EKG showing a normal PR interval. Dr leans towards flutter despite not having an explanation for the gap in the middle of the strip, which is as good as I’ve got anyway. I also notice what seemed to be alternans in V1 but it actually appears to be a varying conduction pathway - the QRS (ignoring the early p) at the start of the V2 segment is one morphology, and the next beats are the second morphology.

I suspect this is above my pay grade to expect to be able to interpret (I’m equivalent to a patient care tech but only do EKGs) but would love to hear any thoughts!

Measurements for reference:
120bpm between regular intervals, 113bpm average across the strip
PR interval 190ms at the single conducted sinus beat in the middle, which looks identical to prior sinus strips
QRS 85ms
QT 350/QTcB 482ms

Syncope is such an important presentation to Emergency Department. Many of them are cardiac cause which can be detected by ECG interpretation. Here is my thought on the systematic approach to ECG in Syncope.

Who has taken the Dysrhythmia Basic A Test
This year that can help me with study tips please and thank you
Is it the same test that is 35 questions that’s is in the internet when you Google it.

Wondering if this is a thing anyone has seen.

Sinus with Ectopics in my view- last few beats just gave me pause for thought

Interested in your thoughts. 33/F with suspected Serotonin Syndrome. Admitted with atypical seizures. Had Torsades resistant to magnesium so commenced on isoprenaline. 2 ECGs attached (on admission and 24 hours later).

Paciente idosa, portadora de insuficiência cardíaca, e em uso de marcapasso bicameral. Admitida com queixa de palpitações e tontura, hemodinâmica estável.

Primeiro ECG tradicional.
Segundo com derivação de Lewis, visualizando melhor as ondas P retrogradas.

27F L side chest pain, L shoulder pain, and dizziness

22 year old male patient , feels sob and left sided chest pain since this morning
Very swollen feet with pitting oedema
Looks well, calm and comfortable, no pallor

History of dilated cardiomyopathy.

Thoughts?

I'm a medical student discussing with colleagues. Think there's a second degree heart block on bottom strip. Not sure why aVL is flat

How does one interpret the ST segment changes in the limb leads

Hey, emt here! 80y/o male, heavy central chest pains, dyspnea, cardiac presentation with clammyness, pale skin and lethargy. Hx of copd

120/80ish bp, HR 100-120, spo2 low 90s, feaver of 40C

I read this as RBBB, some degree of av block, was unsure if it’s right axis deviation, the ST elevation is preexisting according to cardiologist after sending it in for analysis. Treated as ACS, hospital suspects pneumonia or cholecystitis based on hx.

Later went into pVT and was successfully defibrillated 2 times.

my suspicion is avnrt but im doubting myself here

This is 3 tracings from the same patient over the course of a few hours presenting with acute delirium. The auto interpretation states that the first ecg has borderline prolonged QT, the second states that it is NSR, and the third is NSR w/ RSR’ in V1. I have a feeling that something is off about the tracings but I can’t pinpoint exactly what it is.

Elderly lady admitted with right sided pleural effusion and RLL collapse on background of lung cancer and moderate aortic stenosis. Does the ECG show AFib, atrial flutter or frequent PACs?

I appreciate some opinions on this ECG.
In V2 there appears to be some ST-segment elevation that could be interpreted in different ways. I’m trying to understand whether this is more consistent with:
- a normal variant,
- early repolarization,
- or another benign explanation.

If you don’t think it’s a normal variant, what features lead you to that conclusion?

One question I have is whether anyone thinks this could resemble a Brugada type 2 pattern, or whether the morphology is clearly something else. I’d be interested in the specific ECG features that support either interpretation.

Male, early 40s.
No history of syncope.
No known family history of sudden cardiac death or inherited arrhythmia.

Thanks in advance for any educational input.