Rhythm debate

nursej22, MSN, RN · Sep 9, 2015

I agree that seeing the limb leads would help, especially to determine the axis. I see sinus tach with an incomplete left bundle branch block, with possibly left atrial enlargement.

kaylee. · Sep 9, 2015

The answer is in the V leads, specifically V4-V6. These are seen as the first 3 rows top right as well as the bottom row. They show ST elevation with T wave inversion. This is consistent with an MI.

AJJKRN · Sep 9, 2015

Actually, they can be different directions in different leads
Atrial Flutter - Life in the Fast Lane ECG Library

Cool, but not in the same lead like Torsades or multi focal PVC's. I think it would be hard to tell especially with the sawtooth trademark where the flutter waves look the same when you just flip the strip upside down.

SubSippi · Sep 9, 2015

This is SR with a LBBB. It looks like the extra p waves you are seeing are artifact, or just the notched p wave.

F waves are going to be pretty uniform, due to the fact that the same reentry circuit is what's causing the atria to contract (in the vast majority of cases). For me, that rules out a-flutter. And the rhythm is regular, so it's not a-fib.

If you want some more opinions, try uploading it to the figure 1 app. People are always uploading EKGs and asking for second opinions, and you will likely get replies from cardiologists!

hawaiicarl, BSN, RN · Sep 9, 2015

SR, rate = ~105, slight conduction delay, anterior MI evidenced in leads V3-4.

Cheers

Anna Flaxis, BSN, RN · Sep 13, 2015

The rhythm is sinus tachycardia.

Can't say this is an MI. We can't see all the leads, what we can see does not meet Sgarbossa's Criteria, and we don't have an old EKG to compare it to.

michlynn, BSN, RN · Sep 14, 2015

Definitely sinus tach.

gregemt · Sep 14, 2015

ST with LVH and LAE.