I have no clue what’s going on here, could anyone give any insight? Pt on amio, levo, propofol, and precedex. Hx of DVT, DM2, and HTN. Current admit is for gastric anastomotic leak after a Roux-en-Y. HR increased about 20 bpm and pressure increase by 20 systolic and diastolic. Sustained rhythm for 5 minutes and converted back to sinus brady.

28M w/pmh of smoking, mild htn. Currently smokes “hookah” and cigars. Presented w/sob and fatigue.

Agree or disagree with interpretation? Any modifiable factors other than smoking? Genetics maybe, pt unsure of parents cardiac hx but was homeschooled and has not been to any PCP in quite some time.

68 male. Called to simple lift assist without trauma.

On scene. Chaoticly filthy apartment. Obese male naked on floor, appox 500ml of blood pool around him. Apparently in no medical distress. Speaking clearly and loudly. On initial assessment. GCS 13. Confused and violently hostile. Inappropriate words. Not oriented to time place or event. Skin pale warm and dry, Smell of infection in the air. Eyes pearl, follows commands. Cincinnati pass. Lungs expiratory crackles as bases. Scrotum notable: diaphoretic, size of cantaloupe and patient screams at any moment that his testicles are being crushed by his weight, they require frequent movement.

BP134/90 HR 75 SPO2 97%RA BGL 5.0 T36.8

Hx CHF, hepatic encephalopathy, renal failure w hema urine - cath with bag appox 300ml of blood. NIDDM, Anemia,

Meds: lots. New script for digoxin.

Pt not ambulatory, deadweight. 400+lbs. Icy conditions outside. Difficult extraction.

Threatens or swings at us if in range. Fire is called for assistance. 6 fire fighters required to subdue, assist in package and stair chair to waiting ambo, down 14 icy stairs with mix of freezing rain and snow. 120m sidewalk. No sedation possible

RBBB, t wave depression, afib(?).

What can you teach me about this. I believe I spent too long on scene trying to figure out what the hell was going on with the ECG, to determine which hospital I was heading to.

https://preview.redd.it/5a3eo34dxjge1.png?width=1200&format=png&auto=webp&s=dff6df4be72a4273bb5fa14ae35937f7d9ba09eb

Hey I am a med student who sucks at ECGs I can recognise the sawtooth pattern after I flip the ECG around. This is a 2:1 block but I can't see the 2 p waves for every 1 qrs wave. anyone can highlight this for me? thank you! from a struggling student :D

Got

82 f, chest pain sharp to shoulder. Started same day in morning called immediately. Pt had history of afib and an ablation two years ago, COPD. Meds thinners. Last cardiac check was clear and normal sinus 2 months ago.

Couldn’t really get a good picture of this one (I apologize) along with a good scan because the EMT partner I rode with on my clinical shift places leads on UE and LE.

92 F being discharged today from nursing home, so nursing home pt’s nurse decides to make a 911 courtesy call for pt. Anyways, pt reportedly is more confused for last couple of days according to relatives in pt’s room. PMHx: CHF, T2DM, ICD & pacemaker. Very intense urine stench upon entering pt’s room. NKA. Meds unknown; her relatives don’t know and her nurse doesn’t know where her paperwork is lol but is reportedly non-compliant with them. Respiratory: RR 30’s, shallow, clear lung sounds bilat. GCS 13, A&Ox3 doesn’t know time. Physical findings: Occasional bruising as expected with pale, yellowed skin on LE bilat and yellowed fingernails bilat. V/S: HR 70’s via pacemaker, BP 168/92, RR 30 shallow & unlabored, etCO2 29, temp: 98.4, 99% RA.

I’m a learning medic student, let me know your thoughts along with educating me about the different QRS morphology in leads V1 - V3.

83 year old female called EMS after experiencing a prolonged near syncopal episode. Patient had no complaints upon EMS arrival besides ongoing trouble breathing x 5 days. She had been seen at a community ED and diagnosed with Pneumonia a day prior to the call. Had an MI with cardiac stents placed 2 weeks prior, unknown which vessel.

Vitals were stable HR: 80’s BP: 120s/70s Spo2: 93-94% room air.

During work up the patient had mentioned her recent declining health and the fact her husband passed away 6 months prior. Initially thought Wellens type B but inversions were throughout and no recent chest pain but near syncopal could’ve been an equivalent. Thinking some sort of stress induced cardiomyopathy based on story, global T-wave inversions and a QTc of >500. Also considered a PE.

Did the whole ACS thing and transported to PCI capable center. ED doc brushed it off as subendocardial ischemia but I’m not sure I agree. What do y’all think?

My guess was SA exit block type 2. Would like to hear your thoughts on the rhythm in the above ekg. TIA.

• 61 YOM. Syncopal episode getting into car witnessed by wife- brief <30 seconds. This was followed by 8/10 chest pain (described as pressure mid sternum). Hx included kidney disfunction, patient was aware he had a BBB but said nothing more, and no prior MIs. Patient was pale, diaphoretic, and A/Ox4 on arrival. Vitals are: HR 80-90, BP 116/64, RR 20, SPO2 was 88RA and 95% 4L/NC. BGL 154, Temp 98.4.
• En route- ASA, NTG/SLx2, Fent 50mcg.
• 4/10 chest pain was the only change.
• Called it in as a STEMI. Transmitted to ED. Once in the ED, receiving physician said he didn’t have enough to activate a STEMI alert and would consult with cardiology. Requested a patient follow up through EMS liaison.
• I need help filling in the gaps between the duck that I saw quacking vs the bird the physician heard quacking and a possible explanation in the Ekg on what information the physician was lacking?

IF THIS IS NOT ALLOWED I APOLOGIZE. It is just interesting.

I was asking ChatGPT some questions to refresh me on BBBs and it got to the point where the AI asked-

“I can generate an illustrated ECG comparison showing normal RBBB vs. ischemic RBBB with STEMI. Let me know if that would help!”

This is the image 😅

79 y/o male developed sudden onset of SOB 9am in morning walking down the stairs. SOB did not abate all day. Has no CP/dizziness/diaphoresis, just SOB. Excluding HR, all obs normal range. No medical hx and no regular meds. It's not SVT but never got a clear answer from the hospital before we had to leave.

ECG for elderly patient with palpitations. Delta waves mostly evident in inferior leads

Can anyone explain to me how an ashman phenomenon according to this video can cause a left rather than a right bundle branch block??

https://youtu.be/4f2do4mlYOQ?si=r2JsF9ppl-dRnLs8

Witnessed OOHCA by family, had 1x shock delivered by AED prior to EMS arrival, approx 15 mins downtime with 3 shocks provided for Vfib terminating in to the ECG as seen. Any thoughts on underlying diagnosis?

I I'll be simple, is this wellens? So story go like this. Patient have typical heart pain( releveis by ntg, aggravated when he go to outside , on cold weather, he describe pain to be same as when he had MI, retrosternal go to left hand, duration 20 mins) . Patient have 2 stents bcs previous MI, I saw ecg before 3 months and none of leads have TWI or STD. Patient haven't pain ATM of ecg recording. I called cathlab and they said it wasn't for immediate intervention so patient did go to cardiology. I heard that some interventionalita go to catch with wellens and it make sense to me. What's your opinion. Is this wellens type 2 if it is does it go to catch?

I just followed up on a patient I recently had, and I was interested to see if anyone catches anything that I missed that should have tipped me off in the right direction.

Retirement-age woman C/O substernal chest pain. She had been having similar pain for around a month that was diagnosed as musculoskeletal. She called 911 because the pain had increased in severity over the past 24 hours, which is where I come in.

I felt the pain to be more pleuritic, but ran an ECG as CYA. I was concerned for an inferior based on the above tracing. There is obvious inferior and lateral elevation, and I believed the depression in aVL to be significant relative to the amplitude of the qrs. I did see the depression in aVR at the time, but didn’t focus on it.

Coronaries came back clear. A small effusion was found, and she was diagnosed with pericarditis.

Looking back, I think I would make the same decisions if I had this same ECG in front of me again. I don’t see significant PR depression. Slight Spodick Sign is in some leads looking back, but really not enough to tip me towards pericarditis. The elevation also seems regional to me, and aVL looks reciprocal to me. The depression in aVR should have given me more pause, but I think I would still come to the same conclusion.

Anyone see anything that I missed? I’m not sure what to take away from this one.

Trouble with ddx. personally i believe these are blocked PAC’s due to them not marching appropriately & the pause not being double the RR interval.

Thoughts?

Apologies in advance for the scribbling. Looking to see if anyone could interpret these strips.

EMS called for 78F cancer pt in an oncology clinic for generalized weakness and confusion x 3 days. Undergoing chemo for skin cancer. Pt stopped eating or drinking anything multiple days ago. No acute onset of symptoms, progressively worsening x 3 days. No complaints of chest pain or shortness of breath. Afebrile and blood glucose WNL

M71 getting an ECG as a routine check for LBBB. Got hospitalised due to the new onset bradycardia. What confuses me from this strip is: (a) inverted QRS in I and II and (b) in V3 to V6 biphasic p waves. In addition to bradycardia and LBBB I see also a 3rd degree atrioventricular block (I think). Could someone enlighten me?

Can you explain this ECG to me? It’s for my exam next week.

The case :

A 45-year-old male presents to your office with intermittent chest pain for the past few Q1 days, although he is currently pain free after taking aspirin at home. He tells you that while running this morning he had pain every time he ran uphill. The pain is a dull ache on his left chest wall. He has no other associated symptoms and no significant past medical history or family history. His vital signs are stable and a physical examination is unremarkable. An EKG performed at this visit is shown in next slide along with a previous EKG. Which one of the following would be most appropriate at this point? A. An exercise stress test B. Stress echocardiography C. Coronary CT angiography D. Referral to a cardiologist

Considering ‘t wave inversion’ in biphasic qrs complexes. Is anyone able to point me to good resources regarding this, and support with the above ecg analysis…

Above ECG being an incidental finding in 81 YOF with active flu and chest infection. No other cardiac pain, cardiac symptoms or red flags x