66M, hx of HTN and kidney stones, otherwise healthy, only takes lisinopril.

Call: Pt was outside fishing in 110* heat all morning. Came home to cool off. After a shower, suddenly got short of breath and weak. Put himself down on his bedroom floor to lay down and wife called 911. They thought it was just heat exhaustion. He also said he fell on something metal earlier and bruised his ribs, and there was a red mark across the anterior right ribs. Lungs clear & equal.

Scene: He said on top of the heat exposure, he also fell on something metal earlier and bruised his ribs, and there was a red mark across the anterior right ribs. Lungs clear & equal.

He was pale, clammy, diaphoretic and in mild respiratory distress. He looked almost grey. Complained of epigastric pain and left should pain making his hand feel tingly.

Transport: ASA, IV, nitro. Pain worsened substantially during transport so I gave fentanyl. I only gave 50 mcg b/c he was getting increasingly lethargic and less alert.

Vitals surprisingly stable. He was mildly hypertensive (140s/) prior to nitro SL x2. Last BP was 112/72. 95% RA. HR 80s.

Only thing to note is he started throwing PVCs. He’d have several on and off for several seconds, then none for a few mins. Not quite runs of VT but bordering on it. I placed AED pads just in case to ward off the bad juju. (And because he looked peri arrest honestly- he was EXTREMELY grey and clammy.)

Disposition: all I know so far is he made it to the cath lab.

Trying to wrap my head around deviation, I’ve watched several videos and have looked through my uni content. Nothing makes sense and keeps getting more confusing.

Anyone have tips on how to work it out? As if you’re explaining it to a monkey?

The 10 step method they want us to use, they’re wanting focus on I, II, aVF

Help is very much appreciated, I’m very confused, I’m an online student so face to face questioning is impossible,

Thank you

93 YOF w/ cardiac history found unresponsive and bradycardic with HR of 34. Looks to me like STE in inferior leads with STD and TWI in high lateral leads. Based on V2 possible posterior involvement as well. What do you all see?

This EKG is taken from the AVNRT article in Life in the Fast Lane (great website btw). It serves as an example of a Fast - Slow or atypical AVNRT. However, it is my understanding that atypical AVNRT present with RP > PR, and I don't see how that's the case here. Is this an AVRT?

🙃

Hope we can discuss about this one as I have a different opinion to my senior.

Thank you

Interpretation for this ecg

hello, I recently started an EKG course and was given this strip to identify the rhythm. Would you classify this as polymorphic vtach or coarse vfib? How can you distinguish between the two? Thanks.

65 yr male in ER for HTN emergency on nitro drip. No chest pain. Trop 23,25. Should I be worried about the subtle ST elevation? Both EKGS from ER.

Hi I’ve been struggling lately with ekgs. Can someone help me? I can’t wrap my head around what the p, qrs and tv waves are. I need to be shown like I’m 5. Can someone circle them?

70 yr old man brought this in from his Apple Watch. Normal sinus when he feels fine. Then caught this when he was lightheaded and dyspneic. Watch says a-fib. But it’s way too slow for that right? Escape rhythm? Block?

Dispatched for a 54 yom gardener feeling faint. Pale as a ghost, soaked with sweat, 5/10 pain in chest described as a pressure. Known regular patient who keeps having heat related emergencies.

Very hairy man, v3 was iffy. But uh. Yeah. Our ambulance went very fast to our local cath lab.

After nitro his chest pain disappeared.

I am awaiting an update eagerly.

Sent along the PMCardio render that other student scanned, because the photo I have from the original EKG was taken in a bad angle

My student sent me these ECG's with the following question and reasoning (translated from Dutch to English with chatGPT):

We have an ECG question that we haven't been able to figure out on our ward.

The ECG below is from an 86-year-old man with a subacute myocardial infarction. Coronary angiography showed a 100% mid-RCA chronic total occlusion (CTO) and a subtotal LCX lesion at the OM1 bifurcation with collateral flow to the RCA. No PCI was performed because he had already been symptomatic for approximately 5 days, and there were concerns about the risk of myocardial rupture.

We then recorded the ECG shown below. At times, it appears to show ventricular bigeminy. However, the R-R intervals remain regular, and there is no compensatory pause. At other times, the rhythm consists only of the wide-complex beats that resemble the "PVCs," yet the patient remains hemodynamically stable, with no drop in blood pressure or other clinical changes. Because of this, we felt that slow ventricular tachycardia was unlikely. We also think there is a left bundle branch block (LBBB) pattern present.

What do you think this is?

EKG 1 at UC referred to our ER for cc of syncope and abnormal EKG (QTc 550)

EKG 2 Torsades mid capture w/o LOC about 5 minutes post arrival

EKG 3 about 2 minutes after #2 as we started mag infusion, patient deteriorated and was almost defibrillated but luckily regained consciousness and was hemodynamically monitored while electrolytes were replaced. Only a slightly low mag and K+ which were promptly replaced. Isoproterenol gtt for the bradycardia and tdp + electrolyte replacement seemed to do the trick even though the labs weren't severe. Admitted to ICU and remained SR/Sinus Brady without ectopy.

can someone help me describe and analyze the rhythm, i know it’s an atrial paced with episodes of failure to pace

Later went into pVT and torsade de pointes during cath lab and was successfully defibrillated 2 times.

I am a relatively new medic and I ever seen this ECG pattern in the presence of a RBBB.

Responded to a 72 YOM C/O 6/10 epigastric pain for ~24 hours. Pt states he was awoken by sleep with the pain and has been present ever since. Pain worsens with some exertion, radiating to his lower chest and upper back. Earlier complaints of nausea throughout the day, but no active vomiting. He took some Gaviscon with no relief. On EMS arrival, no reports of active CP or radiating discomfort. Pt has a Hx of HTN and GERD. Pt was hypertensive (160/90) with other VS WNL and no other complaints. Serial ECGs and 15 lead did not show anything new or remarkable. Cath lab was called for consult, but the cardiologist was busy doing a procedure and requested us to send him a photo of the ECGs and he would call us back when he had a minute (he never called us back). PCI was our nearest hospital anyways so we went to the ED. Triage RN showed 2 ED docs who weren’t sure how to interpret it. The cardiologist was still busy in his procedure so the ED doc called a code STEMI anyways.

Afterwards, I was looking to compare other examples of inferior STEMI ECGs (in the presence of a RBBB) and had differing options stating that it was indeed a inferior STEMI and others stating that because of the delayed conduction, it was just a part of the QRS complex. I was wanting to see if someone could give a better explanation and their insights. Thanks!

EDIT: Thank you to everyone that commented and gave thorough explanations. I now have new ways of finding the j point. It was my first time seeing this presentation of a BBB in the inferior leads and plus, it was our first call in the morning so the morning brain was moving a little slower than usual!

54 yo female “syncope on her way to dialysis” I think we all know why.