ECG Review: What Might Be Wrong?
ECG Review
What Might Be Wrong?
By Ken Grauer, MD, Professor, Department of Community Health and Family Medicine, University of Florida. Dr. Grauer is the sole proprietor of KG-EKG Press, and publisher of an ECG pocket brain book.
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Figure. 12-lead ECG obtained from a 50 year old woman. What might be wrong? |
Clinical Scenario: The ECG in the Figure was obtained from a 50 year old woman. Without further comment, what might be wrong?
Interpretation/Answer: There are a number of abnormalities apparent in this 12-lead tracing. First, the rhythm is not sinus, as upright P waves are not seen in lead II. Instead, we interpret the rhythm as AV nodal at a slightly accelerated rate of 65/minute. Alternatively, this could also be a low atrial rhythm (some leads, such as lead V3 seem to show very low amplitude P waves preceding each QRS). More information (ie, a longer rhythm strip) would be needed to determine the rhythm with certainty — however, what can be said is that this is not a sinus rhythm.
The QRS complex is narrow. There is an IRBBB (incomplete right bundle branch block) or rSr' pattern in leads V1, V2. This may account for the shallow T wave inversion seen in these two leads. The most remarkable finding on this tracing is the presence of very tall, peaked and pointed T waves in the inferior leads and especially in leads V3 through V5. These T waves strongly suggest hyperkalemia, however this patient's serum potassium level was completely normal!
Additional findings of interest on the tracing include small but definitely present q waves in the inferior and lateral precordial leads, T wave inversion in lead aVL, and marked straightening of the ST segment in the inferior and lateral precordial leads. In view of the fact that this patient's serum potassium level was normal, the combination of an AV nodal rhythm, infero-lateral q waves, peaked T waves, ST segment flattening, and T wave inversion in lead aVL suggest the possibility of an ischemic etiology, which could be of recent origin. The history plus comparison of this ECG with a prior tracing would be invaluable for providing insight as to the likely significance of these findings.
There are a number of abnormalities apparent in the 12-lead ECG image. First, the rhythm is not sinus, as upright P waves are not seen in lead II.Subscribe Now for Access
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