Simple Errors in ECG…..Gross Mistakes..!

Dr.Rajesh Kumar B.

JR Internal Medicine

GMC,Thiruvananthapuram

Situation 1

Sreedharan

59 yrs, Male

DM, Smoker

Chest pain of 3 hours duration

Situation 2

Johnson

45 years

Smoker

No other risk factors

Chest pain of ½ an hour duration

At admission – casualty ECG

Next day before discharging

Situation 3

Santhosh

45 years

Smoker

Family h/o CAD

C/o chest pain x 3 hours

Initial ECG

One space above…..

ST vector in AWMI- proximal to diagonal

Situation 4

Faziludheen

55 years

One episode of syncope – near SCD

No cardiac risk factors

Baseline ECG

One space above

Situation 5

64 yrs, Female

DM, HT, Hypothyroidism, DLP, Obesity

Chest pain of 1 day duration

Rogini!

ECG at casualty

Lead reversals in ECG

Right and left arm electrodes:

Inversion of lead I

Reversal of leads II and III

Reversal of leads aVR and aVL

Right leg and right arm:

Diminished signal in lead II

Left arm and left leg:

Reversal of leads I and II

Reversal of leads aVL and aVF

Inversion of lead III

Right arm and left leg:

Inversion of leads I, II and III

Reversal of leads aVR and aVF

Situation 6

Male, 46 years

Chest pain of 6 hours duration

Smoker

No other cardiac risk factor

Thrombolysed with SK

ECG

Acute Pericarditis

What about this?

Situation 7

74 year old male

Diabetic and hypertensive

C/o breathlessness x 2 weeks

No chest pain

ECG

Echo

Situation 8- TMT

Situation 9

34 year old

Male

C/o atypical chest pain

Occasional presyncope

ECG at casualty

ECG after paper speed correction

Situation 10

66 years old

Female

Uncontrolled Hypertension

Recurrent pulmonary oedema

LV diastolic dysfunction

ECG

Situation 11

Situation 12

28 year old male

Recurrent palpitations

2 episodes of syncope

ECG – wide complex tachycardia

Treated with IV calaptin

Patient developed VF and cardiac arrest

ECG

Situation 13

Girl, 6 years

ASD (OS) - small

VSD (muscular) - small

Congenital complete heart block with one episode of syncope recently

Mild LV dysfunction

ECG

Decided for PPI

Opted for VVIR

Programmed to 80 bpm

Active fixation screw-in lead at RV mid septum

Testing of the lead done…

Testing the lead at 100 bpm

ECG

Testing the lead at 100 bpm

Testing lead at 70 bpm

VVIR implanted – trouble continues

As the patient came out of anaesthesia

VVIR 100 bpm Pacing at 50 bpm

VVIR VVI at 70 bpm

Started on beta blocker

Next day

Before discharge

Comment on this ECG….

Situation 14

ECG : Filter settings

ECG - Filters

Monitor Mode

1 Hz to 40Hz

Diagnostic mode

0.05 Hz to 150 Hz

What are these?