Advanced ECG Interpretations

ECG Challenge Jerry W. Jones, MD FACEP FAAEM Which coronary artery is occluded? Where is the occlusion? Let's have some responses! If you get it right, that means you are very accomplished at interpreting ECGs. If you are wrong, that means you have a great opportunity to become very accomplished at interpreting ECGs! I'll post my response in a few days. Check out my website at: https://medicusofhouston.com Come join us and be a PARTICIPANT... never just an audience!

What To Learn From an Essentially "Normal" ECG Jerry W. Jones, MD FACEP FAAEM  ECG 1 First, I want to say that this is a pretty good ECG for an 88 y/o woman! However, there are a few things to discuss. This post is for the intermediate-level ECG "nerds" but you newbies follow along! First, there is sinus rhythm. We know this because the P waves are upright in both Leads I and II. There is also a POS/NEG biphasic P wave in Lead V1 which is supportive of sinus rhythm. The rate is regular except for one beat near the beginning of the ECG. PEARL: If you want to check the regularity of a rhythm - especially if you suspect that it is subtlety irregular - focus on the T-P intervals and not so much on the R-R intervals. It is often easier to detect rate changes by the T-P segments due to the bordering T and P waves which will make it easier to detect a rate variation. The mean QRS axis (ÂQRS indicates "mean QRS axis") in the frontal plane is normal. We know this ...

  Analyzing an Acute MI “Jones’s Rule” and Primary Repolarization Changes Jerry W. Jones, MD FACEP FAAEM Figure 1 This is another 12-lead ECG randomly selected from my collection. There is a bit of baseline wander, but that’s life! It was recorded on a 68 y/o Hispanic female in the emergency department who was complaining of chest pain. There is no other information about her. First, the absolute basics. We can see by the upright P waves in leads I and II that sinus rhythm is present. The pos/neg biphasic P wave in Lead V1 is also supportive of sinus rhythm. The P wave in Lead V2 is basically isoelectric – but that’s OK, as long as it isn’t inverted or biphasic. There is 1:1 sinoatrial conduction and the P-R intervals are normal and remain the same. The rate is quite variable and may represent a sinus arrhythmia. Also, as we will see in a moment, there is also a good reason for increased parasympathetic influence on the rate. No apparent lethal dysrhythmias and no blocks are not...

                   A Closer Look at Right Bundle Branch Block (RBBB) Jerry W. Jones, MD FACEP FAAEM I once wrote an article about “rabbit ears” and RBBB and posted it on my blog ( https://medicusofhouston.com/dr-joness-ecg-blog/) . To this date it has been the most read article I have produced. So, let’s take a closer look at RBBB.  The  right bundle branch courses down the wall of the interventricular septum on the right ventricular side. Its course is superficial at some points, so it is very susceptible to injury by central venous lines or stretching (dilatation) of the right ventricle. The diagram on the left shows both bundle branches (right – yellow, left – red). With the right bundle branch blocked up high (dotted line), the atrial impulse travels down the left bundle branch into the anterior and posterior fascicles. The left ventricle is depolarized normally and at its usual speed. The first portion of the left vent...