Electrocardiogram (ECG) Quiz

Amer Suleman, Consultant in Cardiovascular and Internal Medicine, Denton Regional Medical Center, Texas.

Please look at this ECG and answer the question below. The answer - explanatory diagram and written explanation are both below that.

Question

What do these rhythm strips show?

A Ventricular Fibrillation
B Torsades de Pointes
C Polymorphic Ventricular Tachycardia
D Artefact
E Atrial fibrillation with aberrant conduction in WPW Syndrome

Answer

See the written explanation below the diagram:

These rhythm strips show EKG artefacts. As you can see all the leads are simultaneously recorded (Yellow Highlighter), although on most of the leads it appears like QRS complex with changing polarity but lead I clearly shows normal rhythm and normal QRS complexes marching right through the uneven baseline (marked by red arrows), Ventricular fibrillation will have irregular rhythm in all leads, Torsades usually has a long short R-R interval before initiating, Polymorphic VT will look same except for findings in lead I, Atrial fibrillation with aberrant WPW conduction can mimic any of choices a, b, c. According to a paper in New England Journal of Medicine, artifacts like above can lead to unnecessary procedures and health cost. This rhythm strip emphasises the need for a thorough and systematic evaluation.

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