Found on the Lifenet Receiving Station

Here’s an interesting set of ECGs I found on the Lifenet Receiving Station. They were transmitted to the emergency department by a neighboring EMS system. I have no details of the history or clinical presentation.

ECG #1


ECG #2


What do you think?

7 Comments

  • SoCal Medic says:

    St Segment Depression in the Inferior Leads with changes in T Wave morphology between the two (looks to be over 5 min). aVR in 12 Lead a has a inverted T Wave without Deviation and in B has ST sgement Elevation with the bi-phasic T Wave morphology. Minimal Elevation in V1 increases into the second 12 Lead along with ST Segment changes/depresssion along with change in T Wave Morphology in V6. My guess is, being that V6 would be reciprocal for V6R, V1 looks at the right part of the Septum, the Inferior Wall could be supplied by the Circumflex, and aVR is positive for elevation (Lead II being hte recirpcoal confirming infarct at that point), I would call it a RVI and see if I can get an activation (based soley on the 12 Lead, either way I would have to really sell it. Am I close??

  • SoCal Medic says:

    Also it is hard to tell if the ST segment elevation observed in V2-V4 stays constant, but I don't like how the ST segment looks or the changes in the overall T Wave between A and B.

  • Tom B says:

    Christopher – Don't over-think it! In the first ECG, the T waves in the right precordial leads are abnormal. But could it be explained by benign early repolarization or the male pattern? The reciprocal changes in the inferior leads are the give-away! I was surprised that the GE-Marquette 12SL interpretive algorithm called ECG #1 a normal ECG.Regardless, ECG #2 tells the tale because there are, as you say, changes between the first and second ECG.Most striking (to me) are the changes in leads II and aVF, but as you say, there are also changes visible in lead aVR.In addition, there are changes in QRS morphology. For example, loss of R wave amplitude in leads V2 and V3.See also:From Dr. Smith's ECG blog, ST depression limited to inferior leads is reciprocal to high lateral wall and represents STEMI.Tom

  • SoCal Medic says:

    Doh. I hate it when I do that. Funny how when you revisit something the picture is easier to grasp. The nice thing about the blog is it allows the opportunity for discussion. Thanks again.

  • Tom B says:

    Christopher – That's exactly what makes Web 2.0 a better medium for learning than a book! I like the feedback. It's helps me learn, too.Tom

  • Simon G. says:

    St elevation in aVR and V1 is indicative of left main occlusion (J Am Coll Cardiol, 2001; 38:1355-1356)..this would explain the lateral supplied by circ and anterior supplied by LAD

  • MM says:

    Working on ANT wall Mi recip. changes Inf/Lat leads. MI

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EMS 12-Lead

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Comments
know it all parapup
83 Year Old Male: Shortness of Breath
@ Kyle I would question your authority to call out people for not having a license or being a know it all parapup when your tx basically entails "call medical control." I think we can both agree that his cardiac output is not great at all. I assume your reluctance to give him any other…
2014-10-30 20:26:11
Kyle
83 Year Old Male: Shortness of Breath
Well st elevation in avr and v1 associated with anterior and lateral depression would call for possible posterior wall MI. 15 lead would be in order. Also check all the leads for appropriate placing. If v7, v8, and v9 show the elevation i would treat as a STEMI per my protocol. Asprin only until medical…
2014-10-30 18:14:05
Tim
The most awesome STEMI test on the internet!
Thanks for the app. It made me think about all that one may see in the field. The only problem was I never got a score or saw the results of how I did other than saying I had completed the test. Anyway a great way to get the old brain working.
2014-10-30 13:14:27
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45

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