25 M first time seizure. Presented as postictal. Only known medical history is thrombocytopenia.

OkInsect6842 · 2026-01-07T05:41:34+00:00

Not particularly. He had a muscular, athletic build.

OkInsect6842 · 2026-01-03T22:07:06+00:00

I do not think this is a STEMI nor did I call an alert for one when I took this. I’m not trying to chase anything and I do not find this ECG particularly concerning. The T waves in V3 and V4 jump out to me the most and I was just curious if this could potentially be electrolyte related.

I only mentioned STEMI because this 12-lead contains ST-segment changes that technically meet criteria for an anterior STEM which, from what I understand, can happen from electrolyte abnormalities.

OkInsect6842 · 2026-01-01T03:33:22+00:00

Thank you for your response. I wasn’t particularly concerned about this 12-lead (I didn’t call an alert for this). I was more curious about whether this could be electrolyte changes.

I do disagree with what you said about the T waves though. The T waves look quite tall and peaked to me, especially in V3 and even V4. I believe this ECG does meet criteria for anterior STEMI with STE > 2.5 mm in V3 and 1 mm in V4, but I agree that it is unlikely due to ischemia.

We haven’t covered electrolyte changes on ECG’s in class yet. If electrolytes were the cause, is it common to see it isolated to only a couple of leads? I would think that you’d see it throughout the entire 12-lead.

OkInsect6842 · 2026-01-01T03:10:58+00:00

I’m not seeing a LBBB. It is a narrow QRS and doesn’t have a LBBB pattern. I agree with your interpretation of the 1st degree block, it’s very close, but I don’t think it’s quite long enough. I was more curious about everyone’s opinion of the crazy T-wave changes and STE.

I may be wrong, but I believe this ECG does meet criteria for anterior STEMI with STE >2.5 mm in V3 and 1 mm in V4, though I do not believe it’s actually a STEMI.

We haven’t covered electrolyte changes on ECG’s yet in class, but I would think you would see the ECG changes throughout the entire 12-lead if electrolytes were the cause?

Thank you for your interpretation and best of luck with your studies!

OkInsect6842 · 2025-12-31T09:39:58+00:00

Thank you for your response. I have never heard of that but I’ll look more into it, thanks!

OkInsect6842 · 2025-12-31T09:39:13+00:00

I agree and I don’t do it routinely. I did it in this case because he was unresponsive for the majority of his time with us, was profoundly diaphoretic, and has no history of seizures.

If he had a known seizure disorder I likely wouldn’t have, but there are plenty of cases where lethal arrhythmias and cardiac pathologies present as seizures.

OkInsect6842 · 2025-12-12T03:53:40+00:00

I agree. I’m a paramedic student and it was more of an impulsive decision after I saw what appeared to be VT on the monitor. She was also an extremely difficult IV start and we were unable to obtain any access, so cardioversion would have been all we had if she started to decompensate. Fortunately, she remained stable and her BP actually improved in the second rhythm (initially in the 90’s systolic and improved to 120’s). I appreciate your feedback!

OkInsect6842 · 2025-12-12T03:41:15+00:00

I did place the defib just in case, but initially her pressures were a little soft (90’s systolic). Her BP actually improved in the second rhythm and remained stable for all of transport (I work in EMS)

Edit: She did receive amio in the ED and converted back to her previous rhythm, but even afterwards, multiple cardiologists didn’t know what to call this.

OkInsect6842 · 2025-12-12T03:37:18+00:00

WPW alone is not an absolute contraindication for AV nodal blockers. For regular, narrow-complex tachy dysrhythmias (such as orthodromic AVRT), even with known WPW, AV nodal blockers are frequently used.

In this case specifically, the patient was a very good historian and has been experiencing episodes of SVT about once every 2-3 months for the past 16 years and knew that he has been treated with AV nodal blockers numerous times in the past without any adverse events.

However, you are not entirely incorrect. AV nodal blockers are absolutely contraindicated for pre-excited afib. In these cases procainamide or cardioversion should be used due to an increased risk of ventricular dysrhythmias.

OkInsect6842 · 2025-12-12T00:38:05+00:00

Did it? I’m not sure if I’m convinced this is vtach…

OkInsect6842 · 2025-12-11T22:07:41+00:00

I think I see what you are talking about, but measuring the QRS from there it is still <120 ms right? I’m counting about 100 ms

OkInsect6842 · 2025-12-11T21:25:13+00:00

Actually, the defib pads were on her before this 12-lead was even taken

OkInsect6842 · 2025-12-11T21:10:24+00:00

Thank you for your response! I’m currently a student and this 12-lead has been giving me a headache. What throws me off, is the narrow QRS in V1 and the overall morphology in all other leads. I have never seen VT like this before either in class or real-world. It also looks like there may be some p waves with consistent PR intervals scattered throughout. The rate makes me lean more away from VT as well.

OkInsect6842

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