Or maybe it wasn’t so subtle, who knows.  I came across a book that some of you may be familiar with, The Subtle Art of Not Giving a F*ck.  It probably applies more to wellness than it does to EKG interpretation, but one of the relevent principles in the book is that problems are inevitable; we will always be faced with them in some form.  Happiness comes from finding a set of problems you don’t mind (or even enjoy!) solving.  Hopefully some of what we’re doing here makes EKG interpretation more interesting so we can cross that off the list of stressors and move on to the latest social imbroglio in room fill-in-the-blank.  Good luck on that one, I’m going to focus on EKG’s.


Today’s EKG is of an 18 y.o. man with cough and CP.  Most of the time that’s going to be musculoskeletal. Some of the time the pain will represent pneumonia.  PE, pneumothorax, and peri- or myocarditis likely round out the bad things differential.

Rate looks fairly normal, the R-R is a little less than 4 big boxes so somewhere in the 80’s.  It’s regular and I see P waves throughout so it appears to be sinus.  I don’t see any of the PR deflection that could represent peri-carditis.

Let’s look at the QRS complexes.  Overall the QRS is narrow, but let’s zoom in on the lateral chest leads.


Closer inspection shows some up-slurring of the QRS that’s also visible in lead I.  The patient has incidentally noted WPW.  Looking at the ST waves I don’t see any abnormalities to suggest peri- or myocarditis.

The take-home from this EKG is likely that findings can be subtle, and don’t always pertain to the chief complaint.  That being said, if they don’t make sense make sure you’re asking yourself if there’s any other explanation as we’ll perhaps see next week.

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