We get called out to this 62yo lady complaining of weakness and nausea, 12 looked okay for the 7-10 mins max on scene (got history from her and husband, she had some tricky corners in the house lol) but as soon as we load her in the unit, she had runs of this every 30 secs or so, lost consciousness twice on us an 8 min transport. The run of that rhythm itself would typically resolve/stop after about 10-15 seconds, then come on again, stop, then start. When she’d lose consciousness it was super sudden, and her head would start to fall back or forward and she’d snap awake about 5-10 seconds later. Everytime she lost consciousness it was following a run of that rhythm on the monitor. During her first run (im referring to the first few secs or so on lead 2+3, the “run” in referring to would cease and return to what the second half of the strip looks like) my medic had me put the pads on as a “just in case” and had me just start driving at that point as he was mostly finished getting his access by that point as well. My medic calls report, then the loss of consciousness episodes happen en route. Upon arrival to ED, we tell them about the runs/episodes, they see the pads are on and we get a room real quick. ED MD walks in the room after hearing talk of vtach from my medic ( patient is awake and alert at this point, just nervous by all the hustle and bustle of her arrival just complaining of mild nausea ) told us we were overreacting to put pads on and that this was artifact. We straight up ask him, “those are aren’t runs of vtach?” He basically kinda blew us off saying that some things are artifact and blocks and pads weren’t necessary, and “if anything ‘pads’ view added to the artifact part” and moved on to talking to the patient right then and there, so obviously at that point it was time for the ol get-nurse-signatures-and-scram thing. My medics logic for pads is he thought she may need to be cardioverted if her presentation deteriorated further.

But anyway, I always love hearing what you guys think. I’m in paramedic school and I’m not gonna lie if I got this on a test I’d have no idea what to call this rhythm, it looks pretty vtach ish to me but there seem to be QRSs? Im unsure what I’d say for final answer. Thoughts ?

TL;DR ugly EKG; ED MD said artifact; thoughts on rhythm, what you’d do if you saw it in the field?

EDIT: SOLVED! Aslanger's sign - This phenomenon occurs due to tapping of arterial pulse on the ECG electrodes, which is known as arterial pulse tapping artifact. YES, THIS WAS ARTIFACT :) I learned my lesson - The patient's left (or right) leg electrode must've been placed on the posterior tibial artery causing artifact - this is why lead 1 looks normal. The pt was in afib and bradying down causing her intermittent loss of consciousness. I very much appreciate all comments on this post, they've helped me learn a lot.

Pt admitted for alcohol withdrawal, no overt cardiac history. Electrolytes were within normal limits.

Hello all, I wanna start this by mentioning that I'm a medical student who is trying to learn how to properly interpret an ecg. A friend of mine sent me this one , hx unknown. She's been telling me this is focal atrial tachycardia but I'm unsure of the heart rate? It seems really low. I'm sorry if this is a ridiculously easy ecg but it's been on my mind for a while and I just wanna know what it may be

With II , III, and AVF elevated + v4 v5 and v6 is this an inferior and lateral stemi? Or am I totally misreading a block

Newish medic here so I'm still learning. What would you call this? My brain wants to call it a-flutter because of previous experiences, I've been told to suspect flutter anytime you have a rate of 150 but I've shown four different medics and no one seems to be able to give it a name 😂

Hey guys I’m a monitor tech and just called this Vtach. I got screamed at by the nurse who said this is SVT. I tried to put as many strips as I could to show all leads. The other techs agree with SVT but I’m having trouble seeing it. Am I wrong for calling this VT? If so can you explain why it’s something else. Thank you!

88yoM sudden onset altered mental, 3/3 Cincinnati droop drift slur, bp 125/57, 48 pulse. Family advised they watched him grasp his head and fall to the ground / no reported chest pain.

Once in the back of the medic 1/3 Cincinnati only slurring words able to follow commands but still confused, similarly I was confused.

60 year old male repeat syncope episodes with significant cardiac history. Initial BP of 54/30 while sitting. Pale, cool, dry. Placed laid flat with a fluid bolus. Negative chest pain, negative stroke. BP improved to 80/50. I brought to Er, MD doing cardiac work up did not stemi activate. Curious what you guys think of the egg.

This one may be clear cut to some of you, but I want to know definitively what this is. I had a stable patient that had an onset of chest discomfort and a noticeable racing heart while doing manual labor outside. Patient was slightly hypertensive and otherwise pretty stable. My plan was to administer amio, but could not get access. Transmitted my 12 lead and ran hot to the ER. Patient converted shortly after self-transferring over to bed. I called this WCT, but final diagnosis was SVT. Apologies for the bad picture of the strip.

Patient reported history of A-fib but none showed on ECG. Patient reported feeling normal. Resting heart rate of 50, Sinus Bradycardia. Patient entered Asystole for 15-20 seconds and re-entered a Sinus Bradycardic rhythm without intervention. No cardiac meds. No pacemaker.

Anyone else seen this before?

Is this AF ?

60ish female came into the ER extremely short of breath with unbearable chest pain. Immediately did an EKG, skin was cool to touch, and resulted with this. Showed to a doctor who activated a Stemi protocol. She said she had no history of heart problems. She was brought back to a trauma bay for about 20 mins before she got sent up to I think cath lab? Not sure. I thought this was an interesting one, had some massive ST elevation in V2 and other leads.

30s Male presents for overdose, sinus tach I don’t think there’s any ST abnormalities, AV blocks, MAYBE RBBB, but there are some weird QRS morphologies and some j point slurring in lead II

Monitor tech is labeling this as a third degree heart block. I guess I’m not understanding why? From my understanding (and I’m still new to EKG’s) third degree heart blocks have dropped QRS’s. Patient flips between this and normal sinus frequently.

Male in his 90s, ems called to the home for shortness of breath. Received from EMS on a nonrebreather and titrated down to 8 L oxymask. No chest pain. No abdominal pain. Only complaints were sob, nausea, and general weakness

Requiring 8L O2, otherwise vitals normal No vomiting. Abdomen firm and distended. Bilateral lower edema to knees. Nonpitting. Some weeping. Rhonchi prevalent in expiration. Labs not super concerning, until the lactate came back at 14. ECG done.

About 2 hours into the visit started having runs of tachycardia up to 150. An hour after that widening qrs, Bradying down and throwing up massive amounts of coffee ground emesis and coding.

Newly diagnosed CHF.

What am I looking at in this initial 12 lead? I have one from 2 months prior if needed

Not sure if I used the correct flair as I'm not a student, but I work as a monitor tech and I only read 5 leads. The other techs and I are stumped on this one. Patient was in a Mobitz 2 at a rate of 70-80 BPM when I first came in at shift change, but as I'm charting my rates and rhythms a few hours later, I noticed there's only one present P-wave. P's march, QRS's march, but the rate is abnormally high for a CHB. We've asked the admitting Doctor what he thinks and he's unsure, so I called the nurse and suggested ordering an EKG. Well, the EKG results came back as accelerated junctional tachycardia (which doesn't really make sense to me). Please help!

This looks like AV dissociation to me but I have no idea. It’s all over the place. 3 different 12 leads all said something different. We are thinking this pt shouldn’t be on our floor and probably needs icu. I could be way off. Any ideas?

Flaired as learning student because I don’t know enough about this pt to have it be a “case.”

Would you call this an nstemi from ecg alone. PT is 60y/o M has Hx of seizures. Called for collapse/unresponsive. Pt became A&O with no complaints aside from fatigue.

thank you in advance!

Is it too irregular to be junctional? Or do those very little squiggles categorize it as an afib?

Hello. This is an ECG I encountered today. Patient information has been removed.

Elderly patient presented today complaining of lower limb numbness and weakness. Past history of pacemaker placement in the last 2 weeks. Diagnosed as TIA today.

Routine work up revealed positive troponins. This was the ECG. Is there ST elevation in the precordial leads or is it not enough to be called that? Why is the QS complex (?) notched in V5?

I’m a recent grad that’s really rusty on ECGs.