CardioNerds ECG Challenge #4

  • Post author:

Question:

56 year-old woman presents to the local ED frightened.  She has a history of anxiety and is on no medications.​
Interpret this EKG

Answer

1. Sinus tachycardia at 107/min​
2. Incorrect electrode placement, specifically RA/LA transposition​
3. Otherwise normal EKG

Learning Points:​

Fright accounts for her sinus tachycardia. With RA/LA transposition lead I is inverted, lead II looks like lead III, aVR like aVL, aVL like aVR, aVF and V1-V6 are unchanged. This arm lead transposition does not account for QRS voltage in V3-V6 which is due to breast attenuation. The R/S ratio increasing from V1-V6 is one clue that this is not dextrocardia.

Show Answer

Powered by EKGaction: EKGaction is much more than the usual textbook of EKG and is different from other online programs.  It teaches/reinforces EKG interpretation skills using a method that integrates clinical pearls that makes it easier to commit to memory.  These pearls accompany every case and are called Learning Points and Collateral Tracings.  The multiple indexes make it useful as a reference. It has been perfected over 15 years, teaching at leading cardiology fellowship programs.  It has been shown to improve performance on board exams and it’s fun to use!

Learn more at https://www.ekgaction.com/