interpret strip
Reading File
Finding Sources
Looking at the strip in the image carefully, here is the full interpretation:
ECG Strip #8 - Interpretation
What I See on the Strip
The rhythm strip shows a lead II-like tracing with the following features:
- QRS complexes: Wide, bizarre, high-amplitude complexes with no clearly discernible P waves preceding them
- Regularity: The complexes appear irregular - the spacing between beats varies
- Rate: Approximately 6-7 complexes visible over what appears to be a 6-second strip, giving roughly 60-70 bpm by the 6-second method (count complexes x 10)
- P waves: Not identifiable - no clear, distinct P waves before each QRS
- PR interval: Not measurable - no consistent P waves
- QRS duration: Wide (>0.12 sec / 3 small boxes) - the complexes are broad and notched
Interpretation: Idioventricular Rhythm / Accelerated Idioventricular Rhythm (AIVR) or Ventricular Rhythm
The wide, bizarre QRS complexes without identifiable P waves point to a ventricular escape or idioventricular rhythm.
Filling In the Worksheet
| Field | Answer |
|---|---|
| Atrial Rate | Not determinable (no P waves) |
| Ventricular Rate | ~60-70 bpm (6-second method) |
| Regularity | Irregular (slightly) |
| QRS | Wide (>0.12 sec) |
| PR Interval | Not measurable |
| Interpretation | Idioventricular rhythm (or Accelerated Idioventricular Rhythm if rate 60-100 bpm) |
Nursing & Medical Interventions
- Assess the patient immediately - check for pulse, LOC, blood pressure (always treat the patient, not the monitor)
- Notify the provider - this rhythm requires prompt evaluation
- Establish IV access and prepare for possible intervention
- Do NOT administer lidocaine - suppressing the ventricular rhythm when it may be the only pacemaker can cause asystole
- Prepare atropine or transcutaneous pacing if the patient becomes hemodynamically unstable
- 12-lead ECG to further evaluate; monitor for deterioration into V-fib or asystole
Key teaching point: Wide QRS without P waves = ventricular origin. If the rate is 20-40 bpm it is a ventricular escape rhythm; if 40-100 bpm it is AIVR; if >100 bpm with wide QRS it is ventricular tachycardia. Looking at this strip, the rate appears to fall in the AIVR range (~60-70 bpm).
interpret this
Question 19 - Full Interpretation
Clinical Context
- 88-year-old, nursing home, "unwell"
- T 35.8°C (hypothermic), HR 74, BP 101/70 (borderline hypotensive), RR 15, SpO₂ 92% RA
- Troponin positive
ECG Findings
Rhythm/Rate: Sinus rhythm, ~74 bpm, regular
Key Abnormalities Visible:
| Lead Group | Finding |
|---|---|
| III, aVF | T-wave inversions |
| V1, V2, V3 | T-wave inversions (deep) |
| V4, V5 | T-wave inversions |
| V1-V2 | No significant ST elevation |
| Overall | No ST elevation in any lead |
The T-wave inversions are widespread across the precordial leads (V1-V5) and inferior leads (III), with no ST elevation - this is the defining pattern of NSTEMI.
Answers
a) Diagnosis: Non-ST Elevation Myocardial Infarction (NSTEMI) ✓
The combination of:
- Positive troponin
- T-wave inversions across multiple leads (no ST elevation)
- Clinical presentation (unwell, borderline hemodynamics, low SpO₂)
...confirms NSTEMI. The other options are incorrect because:
- No evidence of junctional rhythm (P waves present, normal rate)
- No wide QRS or RSR' pattern to suggest RBBB
- HR is 74, not bradycardic
b) Leads with changes: T-wave inversion in III, V1, V2, V3, V4, V5 ✓
The handwritten answer in the image is correct. The widespread anterior-inferior T-wave inversions suggest likely LAD territory ischemia (anterior leads V1-V5) with possible additional inferior involvement.
Clinical Significance
This is a high-risk NSTEMI given:
- Age 88 with borderline vitals
- Hypothermia (35.8°C) suggesting poor perfusion/sepsis co-existing possibility
- SpO₂ only 92% - consider pulmonary edema from LV dysfunction
- Widespread ischemic changes on ECG
Immediate management priorities: Dual antiplatelet therapy (aspirin + P2Y12 inhibitor), anticoagulation, cardiology consult for urgent vs. early invasive strategy, oxygen supplementation, continuous monitoring.
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