25 year old male with chest pain

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A 25 year old male with chest pain presents to the Emergency Department.

Interpret this ECG.

Using the ECG in 20 Seconds method

Rate: 96 bpm
Rhythm: P waves present. Look at P waves. Are they up in II and inverted in aVR? No they are not! This may be limb lead reversal. Look at I and the paves are also inverted.
Beware as one other thing can cause this that we need to acutely know about and that is dextrocardia. If we look at the anterior leads, there is good R wave progression, so this is simple limb lead reversal.

Don’t fall for the trap. This is the one time I didn’t follow the method and thought that this might be significant. BUT…..

When leads were reversed behold:

Now it is normal sinus rhythm.

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.

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