Damn ECG's! Help needed!

G’day all,

I’m a paramedic (ICP/ECP) working in New South Wales in Australia. I was wondering if you could give me a few tips, as I have always struggled with ECG interperatation (I know enough to pass the exams and keep myself out of trouble clinically. I am trying to do some self-education to master this bloody topic, and was wondering if anyone would have any pointers dianosing this 12 lead…

20yof post chest pain, currently asymptomatic. - Don’t worry its not a real patient or an exam, just a workbook question.

30 mins later:

Hey
So just because you asked to give you pointers, im just gonna run this as if it was a question of mine.

  1. Rate and rhythm on strip 2 at the bottom. - so the QRS seems to be appearing at regular and repeat every 4-5 boxes so that would make the rate 300/4.5 = 66 - so the patients HR is normal
  2. Is it a sinus rhythm? and you check this by seeing if there is a p wave before every QRS and yes there is so yes it is sinus.
  3. Then i just move on to look at the leads in their groups. it is helpful to rmemeber what each lead means.
    Leads II, III and aVF - Inferior leads - looking at the heart from the bottom
    Leads I, aVL, V5 and V6 - Lateral leads - looking from the sides
    V1 and V2 - Septal
    V3 and V4 - Anterior
  4. Honestly i am finding it very hard to find any pathologies from the first image because its all over the place, but given the patients age and no symptoms - i am inclined to assume that it is pericarditis or maybe just costochondritis (however i may be wrong)
  5. in the second image i see some ST elevation in lead III but when i look at leads II and aVF which are the neighbouring ones, i see nothing. Again, im inclined to think pericarditis.

Can you confirm whether i am close? i hope this kind of gave you an insight as to how i read ECGs, i am a 4th year MD student so i am still learning too :slight_smile: