Quality Issues and Artefact

Recording a high quality ECG is essential for reliable interpretation and clinical decision-making. Here are some common problems that you might encounter when you are recording a 12-lead ECG.

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ECG Library (164)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Anterior ST elevation Hyperacute T waves Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Acute Chest pain in a 50-something, and a “Normal” ECG 31345

This ECG is from a man in his 50s who presented with acute chest pain.

This ECG shows anterior ST elevation with hyperacute T waves. The cause was a 100% proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Electrical interference artefact Dr Smith's ECG Blog CC BY-NC
What are all these little spikes? 31305

This ECG is from an elderly woman who presented after a fall.

This ECG shows frequent artefact spikes due to a bladder stimulator implanted for her neurogenic bladder.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Nonspecific baseline artefact Dr Smith's ECG Blog CC BY-NC
A Text Message in the Middle of the night. Do you give thrombolytics? Repeat ECG 31367

This ECG is from a man in his 60s who presented with chest pain.

This ECG shows baseline artefact obscuring most features of the ECG.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Delta wave Wide QRS Wolff Parkinson White syndrome Dr Smith's ECG Blog CC BY-NC
What do you think about this Left Bundle Branch Block? 30420

This ECG is from a man with recurrent episodes of tachycardia.

This ECG shows short PR interval with delta waves due to Wolff Parkinson White syndrome.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
Chest pain resolved, and a “Normal” ED ECG 29939

This ECG is from a middle aged male who presented with chest pain. He was pain free at the time of this initial ECG.

This ECG shows subtle inferior ST elevation with reciprocal change in aVL. The cause was a large inferior infarct.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Nonspecific baseline artefact Atrial fibrillation Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Computer often fails to diagnose atrial fibrillation in ventricular paced rhythm, and that can be catastrophic 29617

This ECG is from an elderly patient who presented with a massive hemiplegic ischemic stroke due to MCA thrombus.

This ECG shows atrial fibrillation with ventricular pacemaker and significant artefact. The AF went undiagnosed.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Electrode misplacement Lead misplacement ECG of the Week CC-BY-NC-SA
ECG of the Week – 11th February 2019 – Interpretation 29571

This ECG is from a woman in her 70s who presented after an episode of chest pain.

This ECG shows flat lead II and reversal of III and aVF due to complex lead reversals. These changes resolved with correct lead position.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Inverted P waves Narrow QRS Retrograde P waves Short PR Accelerated junctional rhythm Dr Smith's ECG Blog CC BY-NC
What is going on here?? (The computer called it “STEMI” and “Intraventricular Conduction Delay”!!) 29501
In the ECGquest archives, this ECG has been tagged with: - Hypotension 12-Lead Nonspecific baseline artefact Bradycardia Extra P waves Irregular Peaked T waves Wide QRS Second degree AV block Hyperkalemia Dr Smith's ECG Blog CC BY-NC
What will you do for this altered and bradycardic patient? 29169

This ECG is from a woman in her 60s who presented from a nursing home with altered mental status, hypotension, hypoxia and bradycardia.

This ECG shows an irregular rhythm due to second degree AV block with wide QRS and peaked T waves. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chronic kidney disease 12-Lead Incorrect Machine Interpretation Flat ST segment Peaked T waves Hyperkalemia Dr Smith's ECG Blog CC BY-NC
I saw this computer “normal” ECG in a stack of ECGs I was reading 29139

This ECG is from a woman of unknown age who presented with a clotted dialysis shunt. The computer interpretation was 'Normal'.

This ECG shows peaked T waves and flattened ST segments caused by hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
The computer calls this a “normal ECG”. We’ll just keep making this point. 28863

This ECG is from a middle aged woman who presented with chest pain and dyspnoea that improved after nitrogylcerin. The computer interpretation was 'normal'.

This ECG shows subtle ST elevation in inferior leads with reciprocal changes in aVL. Troponins were positive. The computer misinterpreted the ECG as normal.

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