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It's the ECG's that george rejects that makes George's ECG's the best.
Parkinson’s Disease
Report: Sinus rhythm 80/min SVEB Borderline (-30o) left axis deviation Somatic 5/sec tremor consistent with Parkinson’s disease Comment: Atrial flutter has the same rate – 300/min – as the extrapyramidal tremor of parkinsonism. In this trace, lead 3,
Isoelectric Lead 1
Report: Sinus rhythm Third degree AV block Pacemaker rhythm Reversed arms/legs leads! Comment: Flat Lead 1 is virtually pathognomonic of legs/arms reversal. The P waves also assume retrograde polarity (one is seen in the last cycle in leads 1, 2, 3).
Faulty Calibration
Report: Sinus rhythm Faulty standardisation (upper left-hand corner) Sloping ST segment depression probably due to faulty standardisation Comment: The repeat trace in the CCU was completely normal (Fig 201a below). Instead of receiving an apology and
Pseudopseudoblock
Report: Sinus tachycardia SVEB (second beat) Non-specific ST/T changes Electrode artefact V4-6. Comment: Isolated non-conducted P wave, without any disturbance of the sinus rate, is what a pseudoblock due to a concealed bundle of His extrasystole woul
Somatic Tremor
Report: Sinus rhythm SVEB Borderline LVH voltage Somatic tremor Comment: Fortunately, the tremor from the limbs cancelled itself in lead 2152. The frequency of the tremor, approximately 5/sec (like atrial flutter), suggests Parkinson’s disease. True f
Movement Artefact Simulating VEBs
Report:Sinus rhythm 80/min Within normal limits Movement artefact in simultaneous V4-6 & V1 strip Comment:The computer diagnosed a (single) VEB. If there were a single VEB, it would have been about 0.56” in duration! It is easy to see, once thought of
Electrical Interference
Too Fast for Natural CausesReport: Sinus rhythm SVEBs Left ventricular hypertrophy with ST/T changes Electrical interference Comment: This is not the typical 50 Hz AC interference, but is fast enough not to be a somatic tremor. It’s too fast for natur
Tachypnœa
Report: Supraventricular tachycardia, probably sinus, 108/min Respiratory movement artefact 39 - 44/min Comment: The marked respiratory movement virtually invalidates ECG monitoring. The same would happen to pulmonary artery pressure trace. A side benef
Epilepsy
Report: Sinus rhythm Movement artefact consistent with tremor or fitting Comment: The rapid regular rhythm of both episodes is beyond the power of most percussion physiotherapists; at any rate (or, better, at this rate!), the patient was fitting. Vibrat
A Sticky Roller
Report: Sinus rhythm Right bundle branch block Paper speed artefact Comment: The immediate action would be to check the paper path of the monitor’s writer. Note how, in some of the distorted beats, the T waves are unaffected: it all depends on timing.