You have been asked to review the ECG below for a 38 year old patient who has presented with fever and shortness of breath.
Interpretation:
- Rate: 78
- Rhythm: Sinus rhythm
- Axis: RAD (150-180)
- Morphology:
- +ve AVR, aVL resembles typical aVR
- I is -ve
- p wave inversion I, aVL, V1 (and assoc TWI)
- flat p wave V2
- Intervals: PR 150, QRS 95
- Summary: RA/LA lead reversal
Arm lead reversal:
- Lead I becomes inverted (as you see here, -ve p / QRS / T waves
- Leads II and III switch places
- Leads aVL and AVR switch
(apologies for quality, currently been debunked from our offices for COVID upgrades and having some subsequent technology challenges, hopefully this will be upgraded as our internet access is improved)
To explain how electrodes contribute to leads and the impact this has on your ECG check out a previous post from this blog:
http://www.emergucate.com/2019/07/10/ecg-of-the-week-3rd-july-2019-2/
For lead reversal in general and Einthovens triangle (this is key in understanding ECG lead reversal) have a read of Life In the Fast Lanes post: