Serial 12-lead

Serial ECGs are essential. A single ECG can look normal when the heart is actually diseased, or abnormal when the heart is well. Some arrhythmias may initially look alarming but may be old and well compensated for. Waves that have been inverted from old illnesses can acutely flip to look ‘pseudo’ normalised, unless you compare carefully to the baseline ECG. Baseline ST elevation from a healthy individual can also become abnormally flattened with acute ischemia. T waves can become subtly taller and fatter with early infarction. Electrode misplacements and artefacts may only become apparent when the ECG is re-recorded. Subtle QT lengthening may be seen after initiation of a new medication. ST elevation that is acute vs. chronic carries a different set of possibilities. ECGs taken pain free may differ markedly to an ECG done during a recurrence of pain. Be careful not to assume a previous ECG is a true baseline – it may have been recorded when the patient was in pain / unwell.

Related

ECG Library (202)

Sort by:
TitleDate
ASCDESC
Show:
31230
Columns:
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Wellens syndrome Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing: next morning 31948

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis. This was taken the next day after symptoms resolved.

This ECG shows biphasic T waves caused by Wellens' syndrome.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Left Axis Deviation Sinus bradycardia Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – third repeat ECG on day 2 27514

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 2, after some improvement.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Nonspecific baseline artefact Serial 12-lead Anterior ST elevation Hyperacute T waves Left Axis Deviation Sinus bradycardia Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – fourth repeat ECG on day 2 27517

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 2, after pain returned with nausea and diaphoresis that was exactly like his initial pain.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Nonspecific baseline artefact Serial 12-lead Anterior ST elevation Hyperacute T waves Left Axis Deviation Straightened ST segment Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without -fifth repeat ECG on day 2, after morphine 27520

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 2, after pain returned with nausea and diaphoresis that was exactly like his initial pain and did not resolve with morphine.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Nonspecific baseline artefact Serial 12-lead Anterior ST elevation Pathological Q waves Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without -repeat ECG on day 3 after second reperfusion 27523

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 3, after two reperfusions.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Hyperacute T waves Left Axis Deviation Sinus bradycardia Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – second ECG, as pain returned 40 min later 27496

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG 40 min after arrival, when pain returned.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Anterior ST elevation Hyperacute T waves Inferior ST elevation Left Axis Deviation Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – repeat with worsening pain 27498

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG 12 minutes after the pain increased.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Left Axis Deviation Sinus bradycardia Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – post-intervention ECG 27505

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG post-intervention.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Left Axis Deviation Sinus bradycardia Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – repeat ECG on day 2 27508

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 2.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Anterior ST elevation Hyperacute T waves Left Axis Deviation Sinus bradycardia Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – second repeat ECG on day 2 27511

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 2.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Inferior ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart 26732

This ECG is from This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Anterior ST elevation Bradycardia Inferior ST elevation Lateral ST elevation Normal Axis Regular Shark fin ST elevation Widespread ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart – 40 min later with crushing chest pain 26740

This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG 40 min after arrival when he had a sudden recurrence of crushing chest pain and appeared critically ill.

1 2 3 4 17