3 cases, 17 minutes, "Rocket T-waves" need cath...even without STE!
This is a contrasting follow-up to a posting I made during the record-setting heat of 2012's summer. Today, one of our local news channels here in Richmond, Virginia was reporting on widespread normal axis throughout central Virginia. Note the isolated physiological left axis deviation in the ironically-named “Hot Springs” Virginia.
References / Sources:
1.) WRIC Richmond News and Weather - - WRICTV8 - Home
2.) Blaufuss Multimedia - Heart Sounds and Cardiac Arrhythmias
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Patient data: 64-year old man who, prior to this ECG, had been in normal sinus rhythm. Whatever your level of sophistication in rhythm interpretation (i.e., basic, intermediate, or advanced), this ECG has a little bit of something for everybody. Basic interpreters will undoubtedly recognize the dominant disturbance of rhythm. Intermediate interpreters will probably add more descriptors to their interpretation that will better describe the overall pattern. Advanced interpreters will recognize the unique nature of multilevel conduction and ratios. A laddergram will best elucidate the exact mechanism. I'd like to hear from all types of interpreters.
When teaching ECG, I always try to make the ECG interpretation have some practical context for the student. Why study squiggly lines, if they don't mean something to our care of our patients? Even putting a simple scenario (actual or invented) with an ECG can make it more relevant for your students. A series of ECGs taken as the patient undergoes changes, is especially helpful.
Here, we present six ECGs generously donated to the ECG Guru by Jenda Enis Štros. They follow a man through an acute anterior wall M.I., from pre-hospital treatment, the Emergency Department, Cath Lab, thrombosis of his stent, repair, and recovery. In the future, we will be adding other series of ECGs, labelled "Series" to help you find them on the navigation pane.
With Dr. Mattu's expressed consent, we are posting this week's video.
Are you an arrogant schmuck? Find out in 20 minutes!
The only patient data I have is that this ECG is from a 73-year old man. At the request of the site administrator (Dawn Altman), I'm posting this ECG because there isn't one quite like it in the Guru's archives. Some readers will recognize it as one I recently posted on another website. This one lives up to the title of "Challenging". I'll make the same general statement I did on the other website: You'll need to make careful measurements with calipers on this ECG to come to the correct interpretation.
Sticking with the same general theme from my last ECG Challenge for the months of September and October, 2013. This is more of a back-to-basics for some readers but will still challenge others. No information for this patient other than it was an adult. This is a routine ECG that I performed several years ago on an asymptomatic patient in an outpatient clinic. How would you interpret this?