Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.
Heart rate: Slow (36-42 bpm)
Rhythm: Sinus bradycardia
Axis: Normal
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Do you see anything clearly abnormal?
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Intervals
Appear normal
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QRS morphology
No
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ST segments
No
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T waves
T waves borderline “peaked”; obtaining a serum potassium (K) level is warranted to rule out hyperkalemia.
T wave flattening (TWF) is noted in lead aVF, which is non-specific.
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Is this ECG concerning for ischemia?
Non-diagnostic
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Final interpretation
Sinus bradycardia, possibly peaked T waves, no clear findings of ischemia
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Source
ECG Bank #990
ECG #2
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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.
Heart rate: Normal (60-66 bpm)
Rhythm: Sinus rhythm with 2nd degree AV block, type 1 (Mobitz I) w/ junctional escape beats
The PR interval prolongs progressively until there are two junctional beats (narrow QRS, no preceding P waves, complex #5-6), then the rhythm returns to sinus with 2nd degree AV block, type 1 (Mobitz I) for 2 beats followed by another junctional beat (complex #9)
Axis: Normal
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Do you see anything clearly abnormal?
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Intervals
PR interval: Prolonging
QRS duration: Normal
QTc: Appears normal
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QRS morphology
No significant abnormalities, but there may be left ventricular hypertrophy (LVH) given that the QRS complexes in V2-V3 are touching (Seamans sign)
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ST segments
No significant ST elevation or depression
There is isolated <1mm STD w/ TWI in lead III
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T waves
No significant T wave abnormalities
There is isolated <1mm STD w/ TWI in lead III
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Is this ECG concerning for ischemia?
Non-diagnostic
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Final interpretation
Sinus rhythm with 2nd degree AV block, type 1 (Mobitz I) with junctional escape beats
Possible left ventricular hypertrophy (LVH) due to QRS complexes in V2-V3 touching
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Source
ECG Bank #314
ECG #3
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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.
Heart rate: Slow (54 bpm)
Rhythm: AV dissociation w/ junctional escape rhythm (complexes are narrow)
Axis: Normal
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Anything else abnormal?
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Intervals
PR intervals are varying
QRS duration: Normal
QTc: Appears normal
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P waves
P-mitrale (wide, camel-humped appearing) in inferior leads suggestive of left atrial enlargement (LAE)
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QRS morphology
No significant abnormalities noted
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ST segments
No significant ST elevation (STE) or ST depression (STD)
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T waves
T wave inversion (TWI) in V4-V6, which are shallow and non-specific
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Is this ECG concerning for ischemia?
Non-diagnostic for ischemia
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Final interpretation
AV dissociation with junctional escape rhythm
Left atrial enlargement (LAE) indicated by P-mitrale in inferior leads
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Source
ECG Bank #963
ECG #4
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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.
Heart rate: Slow (54 bpm)
Rhythm: 2nd degree AV block (2:1)
There is a non-conducted P wave every other beat, consistent with 2nd degree AV block (2:1)
Axis: Normal
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Do you see anything clearly abnormal?
‣
Intervals
Appear normal
‣
QRS morphology
No specific abnormalities noted
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ST segments
Significant ST elevation (STE) in the inferior leads (II, III, aVF) with hyperacute T waves
Reciprocal T wave inversion (TWI) and ST depression (STD) in lead I and aVL
ST depression in V2-V3, though motion artifact is noted
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T waves
Hyperacute T waves in the inferior leads
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Is this ECG concerning for ischemia?
Yes, it is indicative of an inferior MI and possible posterior MI
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Final interpretation
Inferior myocardial infarction (MI) with possible posterior MI
2nd degree AV block (2:1)
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Source
ECG Bank #231
ECG #5
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Estimate the heart rate (slow, fast or normal), rhythm, and axis to the nearest quadrant.
Heart rate: Fast (sinus tachycardia initially) and then slow
Rhythm: Starts with sinus tachycardia with alternating bundle branch blocks or bidirectional VT, then becomes atrial tachycardia with AV dissociation (3rd degree AV block with ventricular escape or aberrant junctional beats)
Axis: Not specified
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Anything else abnormal?
‣
Intervals
PR intervals: Varying
QRS duration: Wide
QTc: Appears normal
‣
QRS morphology
Alternating bundle branch block morphology
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ST segments
ST depression (STD) in V5-V6
ST elevation (STE) and STD in aberrant beats, apppear discordant
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T waves
There are disocordant TWI in the initial complexes
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Is this ECG concerning for ischemia?
Non-diagnostic for ischemia but can be considered
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What drug toxicity might this ECG raise concerns for?
Ectopy, atrial tachyardia, bidirectional VT all raise the concern for digoxin toxicity
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Final interpretation
Sinus tachycardia with alternating bundle branch blocks or bidirectional VT, transitioning to atrial tachycardia with AV dissociation (3rd degree AV block with ventricular escape or aberrant junctional beats)
Possible digoxin toxicity
Possible ischemia
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Source
ECG Bank #58
This post is for education and not medical advice.