ECG of the Week – 10th December 2018 – Interpretation

The following ECG is from an 80 yr old male who presented with chest pain.

 

 
 
Click to enlarge

Rate:

  • 84 bpm

Rhythm:

  • Regular
  • Sinus rhythm – P waves best seen in leads V2-3

Axis:

  • Normal

Intervals:

  • QRS – Normal

Additional:

  • Significant baseline artefact
  • ST elevation leads V1-3

Interpretation:
  • Baseline artefact
  • Secondary to pre-existing Parkinson’s disease

 Troubleshooting artefact
  There are multiple factors that can generate artifact during the ECG recording / printing process including:

 

  • Patient factors
    • Implanted devices
    • PPM – Pacing Spikes
    • Nerve stimulators
    • Movement disorders e.g. Parkinson’s, essential tremor
    • Rigors
    • Muscle tremor / activity can be related to pain, hypothermia etc.
    • CPR
    • Habitus – very thin or obese patients, paediatric patients
    • Poor pad contact due to hair
    • Poor pad contact due to moisture – sweating, immersion etc.
  • Lead factors
    • Poor pad contact
    • Pad misplacement
    • Damaged lead or lead connection
  • ECG Machine Factors
    • Inappropriate settings of gain or filtering modes
    • Electrical artifact from power supply
  • Printing factors
    • Low ink
    • Print head tracking
    • Paper alignment
  • External factors
    • Interference from surrounding electronic devices. Relatively rare using newer ECG machines and environmental interference is usually compounded by incorrect machine filter settings.

An awareness of these factors and a systemic approach to addressing each point in the recording process, from patient to printer, is important in addressing recording problems such as artifact and lead mal-positioning.

 
References / Further Reading

Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

Powered by WPeMatico