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Tuesday, 23 September 2014

Autumn Class 1 - Digital ECG Machines

See the ECG below.


Digital interpretation reads:
Normal Sinus rhythm. 
Anteroseptal Infarction, probably old

Are you happy with the computer analysis?

Hopefully not!

The main purpose of this ECG case is to highlight the potential pitfalls of relying on machines. 

Most of us are aware that the digital machines are often 'over-sensitive' and detect minor artefacts which they interpret as abnormalities. But,  perhaps more alarmingly, is their ability to falsely reassure.   (I've even seen a 'barn door' AF reported as normal sinus rhythm). Be warned. Be careful. 

This looks like a first degree heart block. 
(Remember the definition of sinus rhythm recently shared). 

See the lead II rhythm strip - the P waves can be seen, and do have a regular relationship with the QRS, but the PR interval is very prolonged.  

For the time being, we won't get bogged down with details of this one. We'll go into 'blocks' in more detail in a later class.   We'll also talk about 'pathological' Q waves at a later date - machines frequently report 'possible old infarct' when in fact there is little evidence on the ECG. 

By all means use the machine as a cross-checking reassurance - but only after you've made your own mind up. Cover it to start with. Then question it, if it's different. You are probably right. 
There's nothing better than clinical judgement. 

Honest. ;)

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