Wandering baseline

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!

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ECG Library (9)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Wandering baseline Excessive discordant ST depression. Excessive discordant ST elevation Pacemaker spikes Regular Tachycardia Wide QRS Ventricular pacemaker Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Can you see through this wide complex rhythm? 28777

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.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Wandering baseline Bradycardia Extra P waves Third degree AV block ECG of the Week CC-BY-NC-SA
ECG of the Week – 12th November 2018 – Interpretation 27783

This ECG is from a woman in her 70s who presented following a fall at home.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Wandering baseline Anterior ST depression Lateral ST elevation Dr Smith's ECG Blog CC BY-NC
Posterolateral OMI resulting in VT, then R-on-T phenomenon and VF 27468

This ECG is from a man in his 50s who presented with 1 hour of chest pain and shortness of breath. This was his triage ECG.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Wandering baseline Tachycardia Sinus tachycardia Hyperkalemia Dr Smith's ECG Blog CC BY-NC
Could you have prevented this young man’s cardiac arrest? Baseline ECG 26584

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Wandering baseline Excessive discordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
A 50-something with h/o coronary bypass has chest pain and a ventricular paced rhythm – 2, in ED 16400

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.

In the ECGquest archives, this ECG has been tagged with: - Rhythm Strip Wandering baseline Peaked T waves Sinus tachycardia ECG Guru CC-BY-NC-SA
ECG Basics: Sinus Tachycardia, Peaked T Waves, and Baseline Artifact 997