r/EKGs

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

64F, palpitations after mild exertion. Similar episode 2 weeks prior. No comorbidities.

RVOT-VT with fusion beats? (Note: ECG at 50 mm/s!)

Spontaneous conversion to sinus rhythm (also 50 mm/s).

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.

Older male, felt faint and syncopised in a field. No known cardiac history.

Ongoing symptoms of 'not feeling right'

Vitals were all WNL. We made it a STEMI alert even though it doesn't quite meet criteria

My read is that there is Ventricular pacing, but no underlying p waves, suggesting atrial fibrillation. The ST changes are likely due to pacing. Any other thoughts?

EMS call. show up with the pt outside sitting in no noticeable distress, with the fam and not a good historian himself. The fam just got concerned his chronic lower leg edema has increased from the ankles and over the week had increased to no pitting edema up to the knees. Denied chest pain, diaphoretic, N/V. VS all within normal limits on room air.

Hi all!

Having trouble with this rhythm. Not sure whether to call it sinus or afib/aflutter. Here’s my thought process so far:

- R to R looks regular. Rate 140s, then there is a pause, then the rhythm looks like it converts to sinus brady. Since R to R is regular, I’m leaning towards calling it flutter and not afib.

- Someone was calling it afib, is it possible to have a regular rhythm and afib?

- p waves present vs flutter waves? From afar, looks like sinus tach, but looking closely, I can’t tell if those are fibrillatory waves or flutter waves.

What would the full interpretation of this strip be?

Any advice is greatly appreciated! Thank you!

Hey all, I am a paramedic who had a call a few rounds ago that I'm still tossing around in my head. I got the EKGs laid out in order that we achieved them with my interpretation below. Curious as to y'all's thoughts and interpretation.

We, 5 handed fire company (engine and ambulance), responded to a sick case outside a dialysis clinic. On arrival, a 60 yo F is in a wheelchair and adult daughter is stating that her mother just received dialysis after 3 weeks of not going. The patient seems weak and altered, but not in urgent distress, she's able to answer simple questions, denies pain or discomfort. My crew begins getting vitals and demographics, and I go into the dialysis clinic in hopes of getting more info on the patient. We often respond to this facility, and I like to get all the dialysis info from the staff in terms of pre/post weights, volumes removed, their findings, etc.

While inside my medic student runs in and tells me that the patient is in V-Tach. Concerned, I walk out of the clinic and find my crew finishing applying A/P defib pads and getting her moved to the stretcher.

Looking at the monitor I see a fast, narrower complex rhythm. The patient at this point is markedly weaker and seems to be circling the drain. We load her in the back, and while the patient is still mentating (kinda, GCS 10ish) I try to quickly explain to my medic student (who has a very itchy trigger finger sitting on the charge button) that I'm concerned with her history that she's rate dependent due to either electrolyte/fluid shift from the quick dialysis after 3 weeks without or from hypovolemia from dialysis, and that if we shock her and she's not actually in V-Tach, she codes.

I suggest we acquire a quick 12 lead and rule out Axis deviation (V-Tach) to decide if we try and resuscitate her and manage the fluid/electrolyte problem or she rides the lightening.

She chose for us by converting into some of the cleanest Torsades I've ever seen. We synchronized cardiovert at 200J. She is pulsetile for a few more moments, but eventually bradys down, we tried pacing to no avail, and she codes. I drill her real fast and drop a mg of epi while the medic student starts CPR.

Conveniently the dialysis clinic is basically in the parking lot of a Level 3 trauma with PCI capabilities. Very short transport time.

We proceed to help the ED run the code. The medic student gets the tube, we suction a liter of bloody lung butter, but somehow we get a sustained ROSC and 12 lead shows a STEMI (I don't have this EKG).

She goes to the cath lab, codes again, goes to the ICU, codes again, diagnosed with "severe heart failure" and eventually passes.

This was a call that escalated quite rapidly, and while we did eventually get to the cardioversion, and I also don't think that this patient was ever gonna make a full recovery, I would be interested in some feedback.

Here's some of my self critique:

- instead of trying to get a 12 lead, settle for a 6 lead for getting Axis deviation.

- if I had known it was an MI vs dialysis-related I probably would have cardioverted her sooner.

Am I completely off base for thinking it may be worth while to manage the electrolyte/fluid problem instead of cardioversion?

EKG 1- a sinus rhythm, possible ST depression, a run of SVT

EKG 2- SVT/A-Fib w/RVR

EKG 3 - Torsades

EKG 4- Synchronized Cardioversion @ 200J

EKG 5- Sinus Rhythm that eventually descended into a slow PEA.

Looking forward to what y'all have to say.

Monitor Tech. Had this patient for two days (73 M) and HR has been 30-50s the entire time. I’m pretty poor at discerning between the two when the HR is Brady like this so I was hoping for some guidance. HR is 39 and pt has been bigeminal as well.
Any of you experts give some guidance?

Hemodynamically stable, recent LVAD, transitioned amio from drip to PO and he started up with this after being paced at 90 for a number of days.

40’s M, hx DM and CKD, found minimally responsive. BGL read HI, pressure 60/30, initial EKG was textbook hyperkalemia with no ST changes. We gave fluids and calcium + albuterol + bicarbonate, he rewarded our efforts by going into whatever the hell this rhythm is. We were five minutes from the hospital so I just threw cardiac pads on and told my driver to break the sound barrier. It almost looks like a septal MI on top of the hyperk but there’s so much going on, I’m not completely sure. If it is an MI, are there any changes to the treatment plan I should have made? Help me, smart people!

i see wellens syndrome. What do you think

Apologies for the picture of a screen.

Pt has already received treatment for this and got a PM implanted. I’m curious what others think as a few of my colleagues are going back and forth.

\- Average rate of 55 bpm, range of 28-95 bpm.
\- Max RR 2.4 seconds
\- Atrial rate is consistently 160 bpm with variable ventricular conduction throughout and rare ?1:1 conduction.

Last monitor from 2015 showed AFib.

My best guess prior to looking at patient history was a junctional rhythm with underlying atrial tachycardia and high grade AVB. My initial thoughts on the atrial rhythm were AF, but the rate didn’t seem high enough for AFlutter and the consistent rate ruled out AFib in my mind.

Doctor called it atrial fibrillation with periods of regularity due to junctional rhythm with intermittent sinus arrest.

What would you call this if placed in front of you with no patient history?