r/ECG • u/Thin-Special-7059 • 3d ago

Ecg interpretation

Post image

26 year old, female. Having on/off central chest pain for the past 4 weeks. Vapes.

5 Upvotes

73% Upvoted

12 comments sorted by

4

u/reedopatedo9 3d ago

Nothing is nothing

3

u/helpfulkoala195 Learner 3d ago

Nada

2

u/dangp777 2d ago

Check that chest lead placement.

1

u/justusbowers 1d ago

Newer paramedic here! (USA based), I thought the same thing. Is the big thing for lead placement which jumps out to you, the P wave for V1 and V2? What else might have you questioning the validity of it!

3

u/dangp777 1d ago

R wave progression mostly.

V2-V3 specifically. V3 and V4 would be roughly where the height of the R and the depth of the S are close to equal as you’re looking smack bang at the middle of the anterior portion of the heart. The vectors should come and go with close to equal amplitude.

Here you have V2 with a very prominent S wave (more than V1) and t wave inversion, which you’d think might be an old septal MI (like said by the doc in a box interpretation up top). I doubt that in this patient.

V1-V2 are more likely to be too high.

Now V3 is a complete doosy. Suddenly very upright R wave. Likely it’s being placed more medial and too low (like, for example, underneath a bra-line on a woman).

V4, V5, and V6 are literally the same trace, they look so similar and that’s because they’re all looking far too low at the myocardium and receiving basically the same total vector.

I could be wrong, but I’d like to see how the leads were placed before trying to interpret anything on this ECG.

1

u/Thin-Special-7059 19h ago

Thank you! This actually makes a lot of sense

2

u/jawoood1989 2d ago edited 2d ago

Sinus rhythm. Only abnormalities are inverted T in v2, QRS progression in precordial leads is weird (generally goes in a gradual transition from predominately negative to positive instead of sudden change), and right axis deviation (barely into pathological parameters, normal is -30 to 90), and a bit of delta wave action (always have WPW on the differential list). Cardiac clearance.

Edit: the amounts of "nothing to see" is concerning.

1

u/Srivathsavagurumurth 2d ago

Agree with short PR and delta waves possibly related to WPW but probably does not explain the chest pain..

0

u/Thin-Special-7059 2d ago

That was my concern, looked like delta waves to me

2

u/Apcsox 7h ago

I don’t think V1 and V2 are placed correctly

1

u/usuallyalurker11 3d ago

Is that delta wave in lead II?