r/ECG

Hey, maybe someone could tell me what happened.
We had an 88 yo male with known atrial fibrillation. He had an convulsive syncope watched by a family member, chest pain and a headache. No pulse deficite, cold sweat, GCS 14 (eyes 3 points). The 12 leads are from the beginning and his heartbeat was at 41/min for a short time, after 10min he suddenly had intense nausea the heart beat slowed down until asystolie while he had most likely a hypoxic seizure. After short time he had a PEA and went back to the same rhythm at the beginning. He was lying down the whole time and I couldn‘t identify a trigger.
After that he had two more periods of bradycardia (first with a heart rate of 35, second down to 21) and after 0,5mg of atropine the heart rate normalized to minimum 70/min.
The other pictures show only lead II for the time of the asystolie

Currently taking a dysrhythmia course and this came up. I initially answered it as 2:1 A flutter, which is the textbook’s answer, but when I went back to review it I thought it was NSR. I was told that i won’t get a question like this on the test, everything will be straightforward but i just want to know y’all’s thought process through this. TIA!

I am trying to get better at downsloping ST as I get flagged by cardiologist that my calls on down slopping are frequently wrong. I submitted report as up to 1mm of downslopping ST depression in v5 and v6.

Previous echo and holter of patient noted no issues.

At rest ST was above baseline. This was mid stress test, it also appeared like this during recovery and was back at resting baseline before end of recovery.

Any resource or approach techniques would be appreciated.

TLDR

I can’t wrap my head around why this is not down slopping ST depression. Cardiologist said it’s normal and I believe him but I can’t get my mind to compute and see past my error.

Also has Diabetes and BP both .

The p wave is more + on the downslope and not on the upstroke in lead II, so it looks like LA enlargement to me.

The criteria is as follows:

RA enlargement = large first part of p wave in lead II (P-pulmonale) + sharp increase in V1

LA enlargement = large second part of p wave in lead II (P-mitrale) + sharp dip in V1

TIA!

We were wondering about intermittent chb ( seems to be some p waves buried in the T segments) vs frequent pacs etc

Patient has no complaints at the time of the inspection. He notes shortness of breath during physical exertion, denies anginal pain, including in the previous period. According to the ECG from 05/18/2025, no significant dynamics were detected on the ECG series. Troponin T: 23.2 pg/ml → 20.95 pg/ml According to the EchoCG data: no areas of violation of local contractility were detected, global myocardial contractility was preserved, LVEF 58% Is that Wellens? In my opinion, a typical picture of Wellens syndrome is unlikely due to the absence of anginal syndrome and the characteristic dynamics of the ECG. However, the presence of a critical lesion of permanent residence is not completely excluded.

V2,3,4 also have ST elevations.

Lead I doesn’t even have a ST elevations…

There are mild ST elevations in aVL and V6.

Do the T wave inversions allow for more precise localization?

TIA!

Hello,
I’m a paramedic in the US. Last night we had a callout for 18yoM uncon/unresp.

To keep it short and HIPAA compliant, I’ll keep it brief.
He had been drinking, he had a stroke a year prior. Reported syncopal episode. A family member claims he had stopped breathing and had given him chest compressions, causing him to wake up.

I didn’t think much of the 12 lead, I thought initially lead placement was causing the T wave abnormality, so I verified and this was the result.

I sent it to a friend of mine, as the more complicated, intricate 12 leads I tend to be less knowledgeable of and he believes it may be Brugada syndrome. In doing some reading, it appears some of the landmarks are there and I wanted to hear some other thoughts.

Thanks

Paciente com 80 anos, MP implantado em 15/04, com CVE por taquicardia atrial em 15/05, plano de ablação na segunda. Atual: dispneia e dor torácica dependente que iniciou há 30 minutos, sv estáveis.

Elderly 78 female with schizophrenia.CKD stage 4 uncontroled DM

potassium level 6.7mmol

Creat 290

What im looking at

40yo female w/ no PMHx, no recent complaints, suddenly collapsed, cardiac arrest.

This 12 lead was taken ~6min post-ROSC.

24 year old male
SOB ongoing for 1 week with intermittent palpitations and chest pains
Patient is more concerned about feeling feverish and flu like
Currently on ABX for a fever

Took him to a&e just because of the ECG with 2 flipped t waves

83M with symptomatic bradycardia, alert and oriented, HR 33BPM.

What is rhythm between green and red markers? Is it ventricular? Are those capture beats? This is from Holter monitor (not mine)

Woman with PMx of severe kidney failure, heart failure, ablation due to AF and been electrocardioverted x3 for afib/aflutter before. Now initially felt like she had atrial fibrillation for three hours before acute onset of central chest tightness.