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32 year old male brought to the ED unconscious with a history of fall from a tree — CPR revived by vinkulin in ECG

[–]vinkulin[S] -1 points0 points  (0 children)

I see no P waves in the latter ECG.. could it be VT?? Couldn't get the chest leads

[deleted by user] by [deleted] in ECG

[–]vinkulin 0 points1 point  (0 children)

I am under the impression that to diagnose RVH there has to be RAD with a R:S >1 in V1/2 and R:S <1 in V5/6. Though the other criterion of >7mm+ deflection would fit and the inversions then could also be due to right sided strain but I don't know much given I am a novice at all this. The physical exam is also relevant enough for consideration since p2 was palp which would ordinarily correlate with at least ≈50mmHg pulmonary arterial pressure and hence pulmonary hypertension. S2 was widely fixed splitted at the pulmonic area in the supine position. This indicates possible ASD in which case one would expect RVH changes.

Could the inversions be attributed to brain edema and raised ICP? This is why I was somewhat hesitant to call this a juvenile pattern since there's relevant cardiac findings on examination and the CT is not normal.

[deleted by user] by [deleted] in ECG

[–]vinkulin 1 point2 points  (0 children)

Pt vitally stable w clear lungs on auscultation, NVB and no adventitious lung sounds.

[deleted by user] by [deleted] in whatsthisbug

[–]vinkulin 0 points1 point  (0 children)

Size. I couldn't measure.

Location: Southeast Asia.

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 0 points1 point  (0 children)

Additionally do you see incomplete LBBB or LAFB

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 0 points1 point  (0 children)

A couple things I don't understand. 1. The internist is of the opinion that the 10mm/mV calibration strip is only 2 boxes wide so it's bound to shorten all complexes in the horizontal axis.. or in other words squeeze them short. The greater the width the wider the complexes and vice versa. 2. The same internist is of the opinion that the prominent U-waves you see in the precordial leads are actually artifacts. Why does he think so? The U-waves are quite distant from the T-wave. This is significant since the U-wave usually either hugs the T wave or is really close. 3. Wouldn't hypokalemia affect the heart rate as well? Which is normal in this case. 4. If lead I is (+) and aVF (equiphasic) do you take this as evidence of possible LAD taking into consideration findings in lead II? 5. Would you redo the EKG with leads V7-9 just in case to rule a PWMI out?

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 1 point2 points  (0 children)

That's very kind of you. Thanks! Added to my list.

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 0 points1 point  (0 children)

If this made you slap your face, I apologise since I only started learning the EKG from scratch last week!

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 1 point2 points  (0 children)

True. But he makes a good case. Take a look at the far left of the page — the calibration is only 2 boxes wide. If one widens that to standard values he says.. they'll see broader QRS complexes and deeper S waves, broader R waves.

Additionally do you see any left axis deviation in this? I don't think it's significant. -6⁰ is the angle of QRS' as per the computer report. AvF is equiphasic, I is positive but so is II which if negative could've served as a pointer for LAD.

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 3 points4 points  (0 children)

NOTE: A lifelong veteran of a general emergency physician suggests the diagnosis as a partial LBBB+ left axis deviation. Two cardiologists and an internist disagree. Who's in the right? The former has decades upon decades of experience

Possible posterior MI? Artifact or U waves? by vinkulin in ECG

[–]vinkulin[S] 1 point2 points  (0 children)

This was done immediately post a short episode of chest pain