EKG advice

[SternoClyde]

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Hi guys new to forum hope posted in right section. Trying to get the hang of ekgs and got some to look through. History with this case is episode of collapse, no chest pain, no shortness breath. Are the ekg changes significant? (see attachment) thanks in advance in interpreting.Clyde

 

[Jonathan13180]

Hi guys new to forum hope posted in right section. Trying to get the hang of ekgs and got some to look through. History with this case is episode of collapse, no chest pain, no shortness breath. Are the ekg changes significant? (see attachment) thanks in advance in interpreting.Clyde

Without prior ones to compare to it is difficult to say whether the ischemic changes are new, or old.
I would be weary of posting patients info online...Ive seen people posting "homework" in other forums and they have been flagged by a moderator.
If you are concerned that the patients symptoms are cardiac related, then go ahead with a cardiac workup.

 

[OveractiveBrain]

Its sideways and an awful image, but it looks like trigeminy. Two normal beats followed by a ventricular beats. Its Nrml_Nrml_Weird, Nrml_Nrml_Weird.

The ugly looking QRS complexes are ugly because they are wide and tall, but they are inconsistent.

I honestly didn't scrutinize the image in detail, but there are no obvious t-wave or st-segment changes. R-wave progression is present. Normal beats in V1 are normal. P:QRS, QRS, rate is regular. Axis is normal.

 

[sacrament]

Its sideways and an awful image, but it looks like trigeminy. Two normal beats followed by a ventricular beats. Its Nrml_Nrml_Weird, Nrml_Nrml_Weird.

The ugly looking QRS complexes are ugly because they are wide and tall, but they are inconsistent.

I honestly didn't scrutinize the image in detail, but there are no obvious t-wave or st-segment changes. R-wave progression is present. Normal beats in V1 are normal. P:QRS, QRS, rate is regular. Axis is normal.

The QRS axis is normal, but the p wave axis is abnormal and suggests a low atrial ectopic focus. If you wanted to reach a little, you could postulate that the patient's syncope was related to sick sinus syndrome and pauses, and now an ectopic escape rhythm is in play. It's awfully speedy for even an atrial escape however (and would have taken over early on in a pause), so I think this is an unlikely scenario but wouldn't sound bad on an episode of House. There are also purely speculative paths you could go down regarding the ventricular trigeminy, but this is an incredibly nonspecific finding as well.