Nurse Practitioner ECG practice

[sirI]

I thought it might be good practice for us to have an interesting clinical problem each week. Maybe even more often.

Look at this ECG and decide what you think. Infero-lateral infarct, acute inferior infarct with right ventricular involvement or normal ECG.

You can give your rationale if you so choose. If not, it will be given later.

Good luck and have fun!!!!!!!!!

[sirI, MSN, APRN, NP]

Siri...is this your daughter's EKG ? Just curious.

No, thank goodness.

She had MANY runs of V-Tach and Bigeminy, however. I should crop hers and give it as a clinical case, huh?

She is doing fairly well now. I hope things calm down. You know she did not have SVT. The ablation was not successful.

She has total left ventricular involvement.

[zacarias, ASN, RN]

Siri,

Did not know that about your daughter, I'm sorry to hear that.

About the EKG, it looks like pericarditis. I do see ST problems in lead II and V2.

[Teachchildren123]

Sorry about your daughter, I'll add her on my prayer list.

Please, I am begging you to continue with this sort of case study, I'll love it!!! :balloons:

I say this pt had inferio-lateral infarct and his strip start to show thoses fireman hats in the EKG, he/she is having a bad day.

I just pray the God that this pt is not in the ICU on a Friday nite where there is not cardiologist, stat CAT lab... bref like the place where I work (makes me mad: time is muscle)... nothing is working on week-end, even if you are only 39 years old!!!

[cgfnp]

I'm going w/ pericarditis, but this ecg is just a piece. The clinical picture would decide whether you are leaning towards infarct vs. inflammation.

[sirI, MSN, APRN, NP]

I'm going w/ pericarditis, but this ecg is just a piece. The clinical picture would decide whether you are leaning towards infarct vs. inflammation.

Yes, you should consider the entire clinical picture in the real world.

This strip is indicative of an infarct. Unfortunately, there are no symptoms to insert here.

I, too, thought pericarditis when I first viewed this strip, but, the real issue is infarct and where.

You and the others are doing such a good job.

Let me address some issues and I will post the answer and rationale in a few minutes.

[sirI, MSN, APRN, NP]

Sorry about your daughter, I'll add her on my prayer list.

Please, I am begging you to continue with this sort of case study, I'll love it!!! :balloons:

I say this pt had inferio-lateral infarct and his strip start to show thoses fireman hats in the EKG, he/she is having a bad day.

I just pray the God that this pt is not in the ICU on a Friday nite where there is not cardiologist, stat CAT lab... bref like the place where I work (makes me mad: time is muscle)... nothing is working on week-end, even if you are only 39 years old!!!

Thank you, connyrn.

I am glad there is positive response to this thread!!!!!

I will post answer and rationale in a few minutes.

[hrtprncss]

can we have more nursing jeopardy please it doesnt even have to be strictly just ekg based, more case studies this is fun

[sirI, MSN, APRN, NP]

can we have more nursing jeopardy please it doesnt even have to be strictly just ekg based, more case studies this is fun

So glad you think this is a good idea. :balloons:

My plans are to have at least one clinical presentation every week and maybe more if interest is there.

Hey, I just had an idea. Think I will post a poll and see what others think, too.

I will continue this in this forum and all are welcome to come.

[lalaxton]

I have found a great tool that helps with ECG interpretation of MI's called the MI Rule. They have been to some of the NP conferences in the last few years, very handy for those of us who can't always remember what's what!

[sirI, MSN, APRN, NP]

I have found a great tool that helps with ECG interpretation of MI's called the MI Rule. They have been to some of the NP conferences in the last few years, very handy for those of us who can't always remember what's what!

I think you need to share that tool, lalaxton!!

I would like to see more of this in this forum. Thanks!!

Check out the new POLL about these clinical presentations!! Just posted.

I will post the answer and rationale in about half an hour!!

Watch for this!!!!!!!!!!!

[sirI, MSN, APRN, NP]

O.K. Here is the answer and rationale:

Acute inferior infarct with right ventricular involvement

Acute inferior infarct is evident (ST elevation in III and aVF). ST segment is elevated in the precordial leads, thus raising the possibility of an anterior wall infarct as well. But, actually, the precordial leads are right-sided and reflect RV infarct. The clue that these are right-sided precordial leads is that the QRS vector in V6 is opposite from QRS vectors of leads I and aVL. In the left-sided precordial leads, the QRS's in leads I, aVL, and V6 should look similar because these leads face the heart from similar angles.

[hrtprncss]

how tricky of u, hmmm right precordial leads to confuse myself with the anterior wall involvement...j/k