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

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Jewel
53 Year Old Male: Severe Leg Pain
Hmm it appears like your site ate my first comment (it was extremely long) so I guess I'll just sum it up what I wrote and say, I'm thoroughly enjoying your blog. I as well am an aspiring blog writer but I'm still new to the whole thing. Do you have any helpful hints for…
2014-08-31 17:51:28
David Baumrind
All that wiggles isn’t Wellens’
@Gary, by all means, nitpick all you like. I agree with your assessment, and the post has been modified. Thank you for the feedback!
2014-08-30 17:28:16
Gary Huntress
All that wiggles isn’t Wellens’
Not to nitpick but is this really a "slightly leftward axis"? I and AVF are both positive. I put it at about +20 degrees, not leftward.
2014-08-30 11:49:35
Handsome Robb
87 YOM COMPLAINING OF CHEST DISCOMFORT AND DYSPNEA
CHF. 12-lead shows a sinus Tachycardia in the 120s with PACs, besides the anterior leads there's diffuse ST depression, the STE in the anterior leads can be explained by the LBBB, axis is good as well. I wish they posted the EtCO2 waveform so we could see but I'm assuming it's non-obstructive. The elevated EtCO2…
2014-08-30 08:08:22
Christopher Watford
“Bad heartburn” – 82 y.o. female without chest pain.
Brooks, Firstly, thank you for the warm welcome to the club. Secondly, the Glasgow algorithm's only published sens/spec for AMI is 51.6%/97.6% respectively (Tuscon STEMI Database). I've not been able to find any other publications. The GE Marquette 12SL algorithm has been widely studied, but is much older, and ranges in sensitivity from 48% to…
2014-08-29 16:50:14

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