Inverted QRS

[Dinith88]

In isolation, the QRS/picture you were given is likely (for your 'class') to indicate MI. SIRI pointed out why it would indicate MI. If you want to get specific (and likely impress your anatomy teacher), you can also conclude (by this picture) that the MI is 'transmural'. This can be distinguished by the deep Q-wave. 'Transmural' means the infarction has extended through the entire wall of the myocardium.These deep q-waves usually stay with the patient (on subsequent EKGs) for the rest of her life...and can be thought of as scars...and can be seen on someone who's not actively having and MI.

(You can have MI's that dont extend through the entire wall...these are known as Non-Qwave MIs (no Q-waves), non ST-elevation MI, or Acute Coronary Syndromes, etc.)

The elvated ST (again in this isolated picture) lends itself to the acute stage of MI because the ST elevation indicates actively 'dying/injured' myocardium.

Check out SIRIs picture again...and think of like this:

1) ST-segment/T-wave inversion represents ischemic myocardium..

2) ST elevation represents damaged/dying myocardium..

3) Deep Q-waves represent dead/scarred myocardium..

And...like others have said....in reality you need more information and such...but for the purposes of your class i'm betting thats what your teacher was getting at...

[sirI, MSN, APRN, NP]

This could be in any lead. But, most likely in one of the chest leads (V1- V6).

What you are seeing is a very deep Q wave (not an R wave). An R wave is always up; never down.

The combination of pathologic Q wave with elevated ST segment is consistent with Acute Myocardial Infarction.

[FireStarterRN, BSN, RN]

The direction that the EKG is deflecting on the strip indicates whether the electrical energy is coming toward the lead or away from it. A normal 12 lead EKG views the heart from 12 set angles where one can expect the QRS complex to either deflect up or down, depending on where the lead is situated.

If the complex is deflecting in a different direction that would normally be expected, that's a sign that something has happened to change the direction that electricity normally goes. Often that can indicate tissue damage from an MI. The elevated ST segment shows that the heart muscle in the particular lead is taking more time to repolarize because the tissue in that area of the heart has been damaged.

[getoverit, BSN, RN, EMT-P]

Could be, I think you'd really need more information (12 leads, clinical picture, etc) because this could theoretically be a tracing of a neonate with a congenital problem....I doubt it, but it is possible.

FireStarterRN is makes a good point about the deflection of the complex, if the electricity is going in an abnormal direction then there is some degree of cardiac tissue damage or electrical conduction disturbance (usually going hand-in-hand).

and like SirI said, it looked like a precordial lead to me with a pathologic q wave.

If I were in your class, I'd tell the instructor they haven't given enough information....but that's probably one of the reasons they wouldn't want me to go back through school again!!!

[nursej22, MSN, RN]

Cheercml said:

From the other information given, I have come up with the idea of CHF post MI. Does this make sense?

I do not see anything in your example that would indicate CHF.

CHF is is not diagnosed from an EKG although an EKG can have changes consistent with CHF (dilated cardiomyopathy), such as a widened QRS (>.12 sec or 3 little boxes) due to delayed conduction through the bundle branches. A person with left ventricular hypertrophy( dialstolic failure) would have deep S waves in V1 or 2, and tall R waves in V5 or 6, but you cannot tell this from the one lead shown.

[peej]

nursej22 said:

I do not see anything in your example that would indicate CHF.

CHF is is not diagnosed from an EKG although an EKG can have changes consistent with CHF (dilated cardiomyopathy), such as a widened QRS (>.12 sec or 3 little boxes) due to delayed conduction through the bundle branches. A person with left ventricular hypertrophy( dialstolic failure) would have deep S waves in V1 or 2, and tall R waves in V5 or 6, but you cannot tell this from the one lead shown.

ECG is absolutely used in the diagnosis of heart failure. Dialated cardiomyopathy can take the form of concentric where the cardiomyocytes significantly hypertrophy or eccentric hypertrophy where the stretch of the ventricle cant cope and significantly dilates (see Starlings laws). In both cases the ventricle appears large on xray however, more so in the latter case.

It is very important to know the stage of CHF. Ie: chronic (early or late stage) or following MI (chronic on acute). The ECG picture will vary accordingly but some things will stay with the patients ecg pattern indefinately.

The picture you give here is just one of many. For example in late stage heart failure, the heart decompensates due to a massive after load on the heart caused by sympathetic hyperactivity. In this case, you may well see a widened pathological qrs but you will certanly see a drop in the qrs height (relative to their prior ecg).

In the case of concentric hypertrophy of the ventricle the qrs wave will remain high but the ventricular ejection fraction will be low due to the cardiomyopathy effecting the end diastolic volume. So the clinical picture needs to accompany the ECG.

Hope this helps

[Kenneth Oja, PhD, RN]

An inverted QRS complex could be something as "serious as a heart attack" all the way down to having misplaced ECG leads. Some common conditions indicative of an inverted QRS complex include myocardial infarction, ventricular hypertrophy, or pulmonary embolism.

Notify a provider if your patient has an inverted QRS complex and assess for:

• Chest pain, SOB, dyspnea, or tachypnea
• Abnormal blood pressure and/or heart rate/rhythm
• Lightheadedness
• Lower extremity edema
• History of cardiac disease

Check out ECG Wave-Maven, developed by physicians at Harvard Medical School, to do more research. It's an internet-based ECG teaching tool for students and clinicians - including nurses!

[getoverit, BSN, RN, EMT-P]

Before anything, we need to know what lead it is.

[Carrig RN]

That's the problem. We weren't told in the information. The only thing that they told us was that it was abnormal for this particular lead.

[Carrig RN]

From the other information given, I have come up with the idea of CHF post MI. Does this make sense?