Two more ECGs classified under the general heading: “Tracing suggestive of ____ ”. I like ECGs that strongly favor a very specific clinical disorder.
Recently I performed these ECGs on two different patients. They were both recorded a little more than an hour apart and exemplified a common electrocardiographic theme I noticed during that work shift.
The primary goal of this week’s blog is not to determine the name of each ECG’s rhythm but rather what each ECG is virtually diagnostic of.
This sign is commonly referred to by one of two names: (1.) Either by the lead that it appears in or (2.) eponymously named after the doctor who is credited with first describing it.
To date, the ECG machine's computer is not programmed to recognize this particular sign/pattern nor will it make the suggestion to consider this possibile clinical disorder in it's statements printed at the top of ECG. Hopefully, in the future, manufacturers of ECG machines will add this algorithm to their computer's diagnostic statements.
Patients’ clinical data:
- Fig. 1 (Top tracing): 61-year-old black man, underweight, active smoker (long history of tobacco abuse), and persistent cough. The challenge for me was to obtain an artifact-free tracing in between coughing fits. When asked, this patient denied having this medical condition that his provider had diagnosed him with.
- Fig. 2 (Bottom tracing): 70-year-old white man, active smoker (long history of tobacco abuse). When asked, this patient also denied having this medical condition that his provider had diagnosed him with.
Personally, I think that a certain degree of denial goes hand-in-hand in this patient population when confronted with their self-destructive vices.
So, both men have similar (albeit limited) histories and a similar clue on their ECGs. In each of the two ECGs, there is a single lead where the waveforms look nearly identical.
- Hint # 1: The answer to the clinical disorder is a 4-letter acronym.
- Hint # 2: The only thing that superficially mimics this pattern is simultaneously switching the arm cables with their respective leg cables on the same side (i.e., RA reversed with RL and LA reversed with LL)
- (1.) Which one of the 12 individual leads am I referring to and . . .
- (2.) What clinical disorder is that lead a highly specific marker of?
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