r/ECG

Hey there!

My boyfriend came home with this very interesting yet very wonky ecg after his shift as a paramedic. We both work in EMS but were not on the same ambulance today. Because we couldn't find a plausible diagnosis, I encouraged to ask the all-knowing reddit community on here ;):

Patient was female in her 60s, post aortic and pulmonary valve replacement (mechanical), now presenting with nausea, vomiting and cold sweats, but no chest pain. Both nausea and cold sweats regressed after receiving dimenhydrinate i.v..

This ecg was recorded twice at 50mm/s (once with leads placed central, once placed on the distal extremities. They look the same.

There are so many inconsistencies in this ecg that I would rather believe in a misplacement of electrodes than this being an accurate reading.

E.g. the absence of p-waves in all of the extremity leads, the randomness of V5, the inconsistencies with r-progression and s-persistence.. Nothing here really makes sense.

I thought about ectopic atrial rhythm as an explanation for the p-waves, but even then, what is going on in the chest leads, especially V5?

Do you have any ideas regarding this?

Both with the possibility of wrong lead placement and if hypothetically this was an accurate reading.

Any insights would be highly appreciated!

P.S.: My boyfriend had his EMT run the ecg, so he did not double check correct lead placement. Which is why we have no confirmation whether or not the reading is accurate. Guess he will double check next time.😂

Can you help me ? what do you see (yesterday hyperkaliema 5.2 mmol/ l

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

46yo male with worsening exertional chest pain 2 days, right sided parasternal area, slightly brady/hypotensive, smoker. Although the only abnormality was isolated TWI inferiorly and slightly prolonged PR, I sent him for ER ruleout partly due to being in a risk sensitive setting.

I am interested in learning more about isolated inferior TWI's in fairly young males with this type of presentation. I did not have a high suspicion, but have found that inferior MI's are often the first presentation when patients have early coronary disease. Thanks for any thoughts.

Hi all, thought I'd share this interesting telemetry strip with you. Not really a 'help what is this', we know what it is. But thought it was worth a share. For context:

This is a 58yo woman

Reason for admission: Culture-negative endocarditis with aortic valve + root involvement as well as vegetations on the ICD leads

PMH: Multiple thoracic surgeries including CABG and mechanical AVR, therapeutic ICD due to past VT's. Has had a recent devicechange with a poorly healing incision (suspected focus)

What do you make of it? Hope you find it interesting ^^

Answer:

>!Normal sinusrhythm with a hefty first degree AV-block of 440ms, intermitted by pacemaker rhythm of 60bpm with underlying third degree AV-block.!<

>!There was briefly hesitation whether it was really a third degree block, as it could have also been that the SA-node just fired slower than the lowerrate of the ICD, but after examination by a pacemaker technician they found only an underlying ventricular escaperhythm at the times of pacemaker intervention.!<

Hi all for context this pt hasn’t seen a medical professional for 20 years. Appears to be EOL in home 92F. BP 160/100 sats of 92%.

All I can safely say is it’s not normal and would love some guidance on an approach to looking at this ecg.

I know it’s not diagnostic as it’s not a 12.

I know, I know, it's only one lead. But it's got me confused. (Novice here, btw). I see BBB (LBBB?) and maybe AV block morphology leading up to the change, but when it changes I'm pretty confused. Is there a P wave buried in there? Is there some sort of junctional thing going on? PMHx stents and valve replacement 5/2026, ESLD, current ascites.

90 YOM. Outpatient EKG, not acutely unwell. EKG tech here trying to learn

Might be a bit of a reach but was thinking pericardial effusion could be present? Noticed the variable voltage in the Qrs and what looks like electrical alternans.

Student medic here trying to get better with ekgs, was just hoping for an idea why this is just a LBBB, as I initially thought anterior STEMI. Thanks!

Could someone help with this and let me know about the urgency of the results. It’s a family members reading, she has headaches and dizziness and chest pain with activity such as walking up a hill. Angiocath CT testing is not booked until late October, I feel like this is very late?

I understand this is saying there’s been damage to the inferior heart wall and possibly anterior as well. Does this mean there’s been two heart attacks in the past, or can one cause damage in both places?

Hi all, came across this patient today in the Emergency Centre. 28 year old female no comorbidities. Previously seen for ?seizures (history of syncope not clear to patient). CT brain was NAD. Was started on treatment but was lost to follow up. Now presenting following another episode. Just wanted to check that we are not missing anything on ECG as one was not done on initial presentation.

Hello dear ECG community,

A few months ago, I shared with you an ECG course that we had developed. The premise of our course was to make it the most interactive ECG course possible and to take anyone, from someone with little or no ECG knowledge to mastery.

The course was designed for nurses, medical students, and doctors, while also going deep enough that even cardiology specialists could find value in it. What surprised me the most last time was that even people outside the medical field gave it a try, and I received a very encouraging message from one of them.

One thing I noticed, however, is that many people didn't create an account to continue beyond the first lesson. I just wanted to let you know that the second and third lessons are also completely free. You only need to create a free account. (The WhatsApp field is optional, and you can also sign up using Gmail.)

Thank you again for giving me the opportunity to share something we've worked so hard to create.

Below, I've also shared a short video recording explaining each ECG lead. This is part of the third lesson, which is also free to access.

If anyone is interested in trying the course, here's the link to the first lesson:

https://www.drvirtuel.com/ecg/en/lesson/s1/u1/l1

Hi all. Had a preliminary diagnosis pending more tests. Problem is the wait times are so long and the hospital has gone silent. I have a holster ECG booked next month, and I'm waiting for an echocardiogram appointment. Would the diagnosis be correct?