EKG Question

[Marianne11]

What does it mean when an EKG report says: Normal sinus rythym, early transition, otherwise normal EKG?

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[TransFatsRgood]

What does it mean when an EKG report says: Normal sinus rythym, early transition, otherwise normal EKG?

The QRS complex should be negative in lead V1 and positive in lead V6. The QRS complex should show a gradual transition from negative to positive between leads V2 and V4. The equiphasic lead is referred to as the transition lead. When the transition occurs earlier than lead V3, it is referred to as an early transition. When it occurs later than lead V3, it is referred to as a late transition.

 

[Marianne11]

The QRS complex should be negative in lead V1 and positive in lead V6. The QRS complex should show a gradual transition from negative to positive between leads V2 and V4. The equiphasic lead is referred to as the transition lead. When the transition occurs earlier than lead V3, it is referred to as an early transition. When it occurs later than lead V3, it is referred to as a late transition.

Is that bad? Or does it mean the lead was placed wrong? Thanks for the quick reply!

 

[TransFatsRgood]

Is that bad? Or does it mean the lead was placed wrong? Thanks for the quick reply!

Early transition is usually an incidental finding and has no significance unless interpreted with the whole ECG.

Early transition is found in right ventricular hypertrophy and as a normal variant in infants,
Yes, lead malposition can cause this.

If this was the only thing on the ECG, I would not worry about it.

What is the rest of the story behind this patient?

 

[Marianne11]

A healthy patient w/routine EKG pre-op. Dormant auto immune disease, otherwise healthy. It happened today when shadowing, and the doctor said it was nothing, but the patient wanted to know and I couldn't answer. So I got curious. Thanks!

 

[TransFatsRgood]

A healthy patient w/routine EKG pre-op. Dormant auto immune disease, otherwise healthy. It happened today when shadowing, and the doctor said it was nothing, but the patient wanted to know and I couldn't answer. So I got curious. Thanks!

yea, EKG's are not that specific, especially for this finding.

On the other hand, to play the devil's advocate, one example of when this can be pathologic is maybe this patient's autoimmune condition is the CREST syndrome and has occult pulmonary hypertension causing RVH.---simple echo would rule out this.. but I doubt I would go that far from what you are telling me

 

[tripta j]

EKG's are just to detect the heart rythm and rate. doesnt matter if its slightly abnormal, depending if it changes as the leads continue.

 

[TransFatsRgood]

EKG's are just to detect the heart rythm and rate. doesnt matter if its slightly abnormal, depending if it changes as the leads continue.

Sounds like tripta needs to further investigate EKG, last time I checked they still had more use than detecting "rythm",. But I will take easy----

Some of the slightest changes on a EKG can make the difference between life and death. For the matter at hand, early transition is not specific.

For example:
As of 2007 the 5 major cardiac organizations (ACC/AHA/ESC/WHO/WHF) have labeled obtaining a 12-lead EKG a Class I recommendation for initial assessment and stratification of suspected ACS. In fact, based on EKG findings alone, can send the patient to a cath lab
Recognizing the subtle changes is an art, that most physicians won't pick up save those trained in IM, Cardiology, or ER

I would recommend starting here with this tutorial
http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson1/index.html

For those who already have this much down, this is great tutorial but is more of a 2 or 3rd year resident level
http://ecg.bidmc.harvard.edu/maven/mavenmain.asp

 

[CardioP]

The transition may be related to several factors, including posterior myocardial infartcion, anterior myocardial infarctio, left and right ventricular hypertrophy, axis in the frontal plane and ventricular strain.

I didn't get the relationship right in the first time and I couldn't find it on the internet for sometime. Recently I found this very useful site:

www.cardiocollege.com

Loved the animations!!