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Real Doctors (Life Makers)  |  Clinical  |  Medicine & medical subspecialities  |  What's wrong with this ECG? « previous next »
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Author Topic: What's wrong with this ECG?  (Read 17319 times)
dr_b.e.s.m
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What's wrong with this ECG?
« on: /December/ 03, 2005, 04:51:23 PM »

What's the abnormality in this ECG?



18-year-old pre-op ECG for knee surgery



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dr_b.e.s.m
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Re: What's wrong with this ECG?
« Reply #1 on: /December/ 03, 2005, 05:09:33 PM »

Look at lead I , what do you see? ---- >? negative P wave and QRS complex.

As a rule:
Whenever you see a negative P wave and QRS complex in lead I the likely diagnosis is limb lead reversal.

(The left and right arm leads are reversed.)

Another cause for negative P wave and QRS complex in lead I --- > Dextrocardia, but in dextrocardia there is loss of R wave progression in the left chest leads which is not seen in this tracing.



--Notice something more in this ECG. The rate. Is it regular? The number of large squares between each 2 complexes isn't equal in all (ranges from 4 to 5). WHY?
-The variability in heart rate here is due to respiratory sinus arrhythmia, a physiologic finding that is most apparent in younger healthy subjects.


There is a group of normal variants and artifacts in ECG and I think it's important to identify them so as not to be confused with pathological conditions. Insha`allah will try to send more examples.


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dr_b.e.s.m
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Another ECG
« Reply #2 on: /December/ 06, 2005, 05:49:16 AM »

The patient is 40-yr-old female admitted with atypical chest pain.


>> Apply the rules mentioned in the previous example and you'll reach the diagnosis !



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cleo_md
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Re: What's wrong with this ECG?
« Reply #3 on: /December/ 08, 2005, 06:01:07 PM »

Thanks for the EKG's Dr Bahaa Smiley
I am impressed you are good at them.
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dr_b.e.s.m
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Re: What's wrong with this ECG?
« Reply #4 on: /December/ 11, 2005, 02:55:41 PM »

Thank you Dr Nuha. Smiley

I saw a patient in the ER with his ECG showing inverted T waves , we thought it's ischemia or something but the cardiology resident said that it's just lead reversal and ordered a new ECG that was normal !  That's why I feel that the ECGs artifacts are important.


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dr_b.e.s.m
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Re: What's wrong with this ECG?
« Reply #5 on: /December/ 11, 2005, 03:41:10 PM »

In the second ECG,

Looking at lead I , we'll see inverted P waves and complex. The rule says that: "Whenever you see a negative P wave and QRS complex in lead I the likely diagnosis is limb lead reversal."

But we must exclude the other diffrential diagnosis first (dextrocardia).

Look at the chest leads, what about the R wave progression? If it's good then it's limb reversal , if it's lost then it's dextrocardia. Here it's lost ( there is no gradual increase in size of R wave as we go from V1 to V6) so it's Dextrocardia.

What else would you like to do for this patient?

I think it's important to exclude other congenital anomalies assosiated , you order a plain Xray abdomen (looking for situs inversus totalis, where you'll find gastric air on the right side, it has no serious adverse health consequences per se, and the condition often goes undetected but it may affect the diagnosis of come clinical conditions later on like acute abdomen so it's better to find it and tell the patient) and ask also about history of sinusitis, pulmonnary infection and? bronchiectasis? (Kartagener's syndrome - immotile cilia).





This is the X-ray

revealing dextrocardia (cardiac apex to the right) with the presence of gastric bubble to the right






and here is another ECG showing Dextrocardia:


« Last Edit: /December/ 23, 2005, 02:04:35 PM by dr_b.e.s.m » Logged
 
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