Movement Artefact
Report
Sinus tachycardia 141/min
Borderline left atrial abnormality (LAA)
Counterclockwise rotation (early transition)
Non-specific ST/T changes
Movement artefact in standard leads
Comment
The artefact in Lead 1 mimics a dimorphic couplet of VEBs, and a single VEB in leads 2 and 3. Each presumptive VEB has, however, a normal QRS complex simultaneously recorded in another lead, settling the matter. This is a good example of the value of multi-channel recordings. Of course, had lead V1 been used for the rhythm strip instead of L2, the movement artefact would have been more easily unmasked. I continue to be surprised how many people think the artefact is a couplet of VEBs.
The significance of the rhythm disturbance? Well, sinus tachycardia can be called that – but may be completely appropriate in this setting. In fact, its absence would imply chronotropic incompetence in the face of pulmonary œdema, perhaps the effect of beta blockers in this setting.
Another trick question, this was.
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