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Interpret this ECG

Tags: karuturi.cardiology.rounds

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1. Sinus Arrhythmia

2. RBBB

3. V4, V5, V6 Electrodes removed

Would be helpful to have some data of the clinical setting-case history.

Sinus Rhythm no doubt.ST downward slope in  the inferior (II.III,avF) and Right precordial (V1-V3)leads indicating Right Ventricular Strain -possible Right ventricular hypertrophy.No RBBB as far as i can tell. 

V4-V6 not recorded

This is a Dog's ECG. I posted this to stress the importance of "medical history taking". Never interpret an ECG or X-ray or CT scan or MRI without history. A disease is a constellation of signs, symptoms, lab values and radiographic findings. Never interpret anything in isolation. Always ask for comprehensive medical history. 

 

The medical history or anamnesis (abbr. Hx) of a patient is information gained by a physician by asking specific questions, either of the patient or of other people who know the person and can give suitable information (in this case, it is sometimes called heteroanamnesis), with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient.

 

In case, if you want me to interpret this ECG in a vet point of view, this dog's ECG shows low amplitude QRS complexes and so you can think of Pleural effusion or Pericardial effusion or Obesity or Hypothyroidism or Pneumothorax or Diffuse myocardial disease or it may be a Normal variation. 

?Paced rythm, A sense Vpaced. -appears to have spikes in Ld  2. ?RV dominant./Incomplete RBBB. 3. V4-6 not recorded

Paced Rhythm with RBBB? you mean LV Pacing going on.....?

Doesn't appear so.

I thought the ECG was taken in some experimental settings. See the Ld 2 rhythm strip is taken at a different speed and possibly not simultaneous with the rest of the ECG.The RR interval after the 5th QRS in the rhythm strip  is 7 small squares which don't appear to correlate with any of the other RR intervals in the ECG.This I dont know is possible with any commercially available ECG machine.The initial few beats appears paced due to the ?spikes. It may be also possible that the V4-6 happened with stopping of pacing since the rhythm strip is not appearing simultaneous. In the RBBB it may be paced with spikes not visible or it may not be paced at all.All are speculations in the absence of clinical setting......Anything possible in an experimental setting! Or as you said it may be just a sinus arrythmia with RBBB/RVH. I would like to know whether the Ld 2 is simultaneous and whether any such ECG machines are available where you can set a different speed for rhythm strip.

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