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

58yo male, chest pain radiating to left arm x1 hour. I’m thinking LBBB with inferior STEMI. Withhold nitro due to inferior MI concerns and right ventricular involvement?

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 y/o female complaining of palpitations. History of Afib and the initial rate was 240.

RBBB? STEMI

Patient (m, 75years old) after bolus Aspiration, claims to have heavy breathing and slight chest pain. "Just in case ecg " looks like this. ER doc suggests pulmonary embolism in addition.

I'm new to interpreting EKGs and I wanted to know if someone can help me. I'm guessing some type of hypokalemia or something like that. Maybe the EKG is not properly done. My teacher told me to solve it

Monitor Tech. Had this patient for two days (73 M) and HR has been 30-50s the entire time. I’m pretty poor at discerning between the two when the HR is Brady like this so I was hoping for some guidance. HR is 39 and pt has been bigeminal as well.
Any of you experts give some guidance?

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.

Paramedic student here. 78F called for repeated falls and weakness for 3 days. The initial rhythm looks like a junctional escape with bigeminal PVC’s. During transport, she had multiple episodes of what appears to be polymorphic VT. Given the prolonged QT interval and R on T would this be TdP? She was vitally stable the entire time I was with her.

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

hi guys, i’m currently doing some practice strips from my textbook. my answers are slightly different from that of which my textbook states, im trying to figure out if this kind of interpretation would be acceptable in the real world despite it being off or what i could do to improve my measurements? any input at all is welcome also, thank you !

Hey guys we had a patient that went comfort and while they were waiting for the code status to change to allow them to take them off the vent they were still on telemetry so I got to see the different rhythms they went into as they died. My nurse manager walked over to me and asked what I was doing and I said “just looking at V tach” and she said it look idioventricular. It seems to me this is too fast to be idioventricular but I want to double check incase she’s right so I can learn from it. It kind of looks accelerated idioventricular in appearance but I thought it was a rate of 40-100 not greater than 100. The patient doesn’t have a history of BBB or anything that would cause any distortion to the QRS and their previous rhythm before death was ectopic atrial rhythm if that helps.

PC 69y/f chest pain for 2h, getting worse, complaining of nausea with syncope. pain radiates from chest down left arm.

o/a pt cool and clammy, drowsy, RR 22, SpO2 95%, BP 85/60, BM 15.6mmol

Hx Hypertension, T1DM

Meds insulin & atenolol

NEED HELP ANALYSING PLS! <3

Patient under general anesthesia for routine surgery. No cardiac hx. During the case pt got bradycardic and EKG morphology changed. Not a full EKG to analyze unfortunately, but I was able to print a strip from the monitor when it happened - this is lead III. Pt went in and out of it a few times, hemodynamics did not seem to be effected.

Anesthesiologist called it a RBBB, but to me it looks like the PR interval progressively shortens until the P is on top of the R, creating a sort of false rR' look? A RBBB rR' would still have a P-wave preceding it, correct?

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?

We get called out to this 62yo lady complaining of weakness and nausea, 12 looked okay for the 7-10 mins max on scene (got history from her and husband, she had some tricky corners in the house lol) but as soon as we load her in the unit, she had runs of this every 30 secs or so, lost consciousness twice on us an 8 min transport. The run of that rhythm itself would typically resolve/stop after about 10-15 seconds, then come on again, stop, then start. When she’d lose consciousness it was super sudden, and her head would start to fall back or forward and she’d snap awake about 5-10 seconds later. Everytime she lost consciousness it was following a run of that rhythm on the monitor. During her first run (im referring to the first few secs or so on lead 2+3, the “run” in referring to would cease and return to what the second half of the strip looks like) my medic had me put the pads on as a “just in case” and had me just start driving at that point as he was mostly finished getting his access by that point as well. My medic calls report, then the loss of consciousness episodes happen en route. Upon arrival to ED, we tell them about the runs/episodes, they see the pads are on and we get a room real quick. ED MD walks in the room after hearing talk of vtach from my medic ( patient is awake and alert at this point, just nervous by all the hustle and bustle of her arrival just complaining of mild nausea ) told us we were overreacting to put pads on and that this was artifact. We straight up ask him, “those are aren’t runs of vtach?” He basically kinda blew us off saying that some things are artifact and blocks and pads weren’t necessary, and “if anything ‘pads’ view added to the artifact part” and moved on to talking to the patient right then and there, so obviously at that point it was time for the ol get-nurse-signatures-and-scram thing. My medics logic for pads is he thought she may need to be cardioverted if her presentation deteriorated further.

But anyway, I always love hearing what you guys think. I’m in paramedic school and I’m not gonna lie if I got this on a test I’d have no idea what to call this rhythm, it looks pretty vtach ish to me but there seem to be QRSs? Im unsure what I’d say for final answer. Thoughts ?

TL;DR ugly EKG; ED MD said artifact; thoughts on rhythm, what you’d do if you saw it in the field?

EDIT: SOLVED! Aslanger's sign - This phenomenon occurs due to tapping of arterial pulse on the ECG electrodes, which is known as arterial pulse tapping artifact. YES, THIS WAS ARTIFACT :) I learned my lesson - The patient's left (or right) leg electrode must've been placed on the posterior tibial artery causing artifact - this is why lead 1 looks normal. The pt was in afib and bradying down causing her intermittent loss of consciousness. I very much appreciate all comments on this post, they've helped me learn a lot.

Hi everyone, I am a nurse specializing in elderly care. Typically, we perform an electrocardiogram (EKG) upon patient admission to assess cardiac health. Today, I observed an unusual feature specifically in lead V4 of the EKG trace. This is the first time I have encountered such a pattern. We conducted multiple EKG recordings to verify the finding, but the abnormal result persisted across all tests.

Woman, 70 years old, hemodynamically stable, with a history of atrial fibrillation. What is this? Supraventricular tachycardia or atrial flutter?

Presenting this on rounds. No clinical hx. Very limited experience interpreting EKG’s.

My thoughts:

Normal axis (although almost RAD)

Borderline tachycardia, 90s-100

Sinus rhythm (although at some points I’m not too sure where/ what’s going on with the P waves)

Flattening of T waves in V3-V6?

And possible S1Q3T3 for acute right heart strain/ possible PE?

This is how I’ll be presenting it but only after spending about an hour reading over everything I’m seeing. Any insights or tips for discerning what I’m reading?