EKG interpretation help

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We just started our cardiac module. I was given a random EKG strip from the hospital to measure/interpret Lead II and am having a devil of a time deciphering it. It doesn’t look clear cut like any of the rhythms we’ve studied in class. I know how to measure intervals, but I’m having trouble even figuring out the basics, such as:

1- where exactly does the p wave start ?

2- Is the t wave inverted?

3- What is the notched downward deflection between the QRS? Could that be an inverted p wave?

Any help in figuring this out would be appreciated.

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Specializes in Stepdown . Telemetry.

When one lead looks very hard to interpret, or just weird, always look at another lead for clues. The top lead has little notches that are bizarre, but if u look below, they are in fact qrs complexes.

We are likely looking at lead placement that is off. That usually Is the cause of really tiny QRS complexes.

This is a weird strip but looks like sinus with ventricular bigeminy?

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Anterolateral subendocardial ischemia.

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24 minutes ago, juniper222 said:

Anterolateral subendocardial ischemia.

And you came to this conclusion how?

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46 minutes ago, chare said:

And you came to this conclusion how?

http://www.medicine-on-line.com/html/ecg/e0001en_files/14.htm

I'm probably wrong but just looking into the ST seg depression and invited t wave. If you have anything helpful you wish to add, by all means please do so.

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Specializes in Critical Care.

I would agree with Kaylee, although it's not clearly sinus, but there are bigeminal idioventricular beats, inverted T-waves are not unusual with ventricular beats. The nearly imperceptible QRS's in the upper lead, which are shown to be QRSs in the lower lead, are likely the 'normal' supraventricular beats, but there are no clear P-waves, so these could be junctional beats. They could also all be junctional beats, with an intermittently variable conduction pathway (all beats originate in the same place, the junction, but with impulses taking two different routes from there).

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What a terrible way to try to learn this at this juncture of your learning/exposure.

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20 hours ago, juniper222 said:

http://www.medicine-on-line.com/html/ecg/e0001en_files/14.htm

I'm probably wrong but just looking into the ST seg depression and invited t wave. If you have anything helpful you wish to add, by all means please do so.

Yes, the changes here might be seen as a result of either a STEMI or nSTEMI, however to diagnosis either you should see changes in 2, or more, contiguous leads, which you don't have with the rhythm strip provided. What you have here, (ETA) as Kaylee and Muno mentioned, is likely a bigeminal ventricular rhythm with an unusual "normal" QRS complex, likely a result of misplaced electrodes or poor contact.

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48 minutes ago, JKL33 said:

What a terrible way to try to learn this at this juncture of your learning/exposure.

Yes, this is not a typical ECG strip, and definitely not one that should have been given to a beginner.

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Specializes in Critical Care.
4 hours ago, chare said:

Yes, this is not a typical ECG strip, and definitely not one that should have been given to a beginner.

This is definitely is not strip with a clear-cut rhythm, you could probably show it to a number of electrophysiologists and get interpretations that vary at least a little, so expecting a "correct" answer from a student would be unrealistic.

But for learning to evaluate the underlying physiology the EKG rhythm reflects this is actually a pretty good one.

I don't know if the OP or other students are still visiting this thread, but if so, what other waveform(s) would be helpful in evaluating the significance of different parts of these strips?

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It also looks like there is a little delta. Too bad it's only a 2 lead strip.

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Specializes in Former NP now Internal medicine PGY-3.

Pvc every other beat so looks like bigeminy. Hopefully they aren’t asking you for much more than that just off those two leads

On 2/22/2020 at 6:31 PM, MunoRN said:

This is definitely is not strip with a clear-cut rhythm, you could probably show it to a number of electrophysiologists and get interpretations that vary at least a little, so expecting a "correct" answer from a student would be unrealistic.

But for learning to evaluate the underlying physiology the EKG rhythm reflects this is actually a pretty good one.

I don't know if the OP or other students are still visiting this thread, but if so, what other waveform(s) would be helpful in evaluating the significance of different parts of these strips?

Pretty much need the entire ekg to determine anything. Never understood why nursing instructors wanted us to pick out everything off of one waveform. It’s silly and cardiologists would laugh at that expectation

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