A wandering baseline can be a frustrating occurrence that makes interpreting the ST segments very difficult. Try to get the patient to relax (stop moving around), breathe calmly (if possible) and check the electrodes are in good contact with the skin. Sweaty patients are a challenge!
See also: Quality Issues and Artefact
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- Rowlands, A and Sargent, A (2019) - The ECG Workbook, 4th edn, M&K Publishing
- (2015) - ECG Interpretation Made Incredibly Easy!, 6th edn, Lippincott Williams & Wilkins
- Wagner, GS and Strauss, DG (2013) - Marriott's Practical Electrocardiography, 12th edn, LWW
- Nurseledclinics (2011) - www.fastlearnecg.com : Simple reading and Interpreting of a 12-lead ECG (EKG) - Yes you can do it!, (Accessed: 10/09/2019)
This ECG is from a man in his 70s who presented with intermittent dyspnoea and chest pain over the past 2 weeks. He had a history of a pacemaker, heart failure, aortic stenosis, diabetes, hypertension, stroke, ischemic heart disease, chronic kidney disease and peripheral vascular disease. This was his initial ECG.
This ECG shows a wide complex tachycardia with ventricular pacing. The excessively discordant ST changes in V4-6 and aVR suggested diffuse subendocardial ischemia. He was found to have severe three vessel disease and a proximal left circumflex stenosis was stented.
This ECG is from a young man who was found at the bottom of his basement stairs. He complained of right hip or leg pain but seemed confused about what had happened. He had a history of IV heroin abuse. Shortly after he had a wide complex PEA arrest and had a ROSC after 20 min of resuscitation with epinephrine, glucose, calcium and bicarb. This was his baseline ECG from a previous presentation.
This ECG is from a man in his 50s who presented with chest pain on a background of previous CABG and dual chamber pacemaker. This was the repeat ECG on arrival.
This ECG shows a wandering baseline making ST interpretation difficult, but a ventricular paced rhythm with excessive discordant ST depression in aVL and borderline excessive discordant ST elevation in inferior leads. The cause was an inferior and right ventricular infarction.