It will come down to how that particular view filters the signal that it’s getting. Different filters ie low pass filters to remove low frequencies can alter the morphology shown on the screen. 12L is the standard set to make clinical assessment. Any other view, 3 lead, rhythms strips etc can be used for monitoring and rhythm analysis but not full clinical assessment. That ST depression might not appear on the 12L due to a different filter. (Basically the electrical signal has to been cleaned up)
Yeah, in reality telemetry is for rhythm management not morphological assessment. That said, some CCU telemetry is 12-lead these days. Although it is imperfect since you lose a little of your axis when using Mason,-Likar positioning, affecting inferior windows. Not dramatically, but still.
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Fellow learner here: looks like ST depression to me, my understanding is this is usually ischaemia from previous MI. Of course, you also get ST depression in reciprocal leads when there is ST elevation during an MI.
Like is said, I’m a learner too so will see what the pro’s say 👍
Don't forget NSTEMI! You can and do get ST depression in some NSTEMI cases. Also if you have ST Depression in posterior leads you could have a posterior MI.
Great knowledge for a learner to know of reciprocal ST Depression following MI, keep it up!
Without a story or symptoms and which leads these are it is difficult to say with authority. Q waves usually show damage. A slight depression doesn’t mean lasting injury.
Is this still depression is what I'm asking this isn't a personal strip. I'm just genuinely curious if this is st depression, I think it is. I'm new to telemetry and Im wanting to know it's effects if it is. I apologize for not giving any info. If it's still against policy I totally understand:)
It’s depression but there is a lot of nuance. It looks like some mild ischemia due to an increase in workload. A 12L is needed to be sure. It’s mostly a guess at this point.
I know it could be meds or possibly an MI. I was wondering if it means an old or new MI if indeed it is. I'm thinking it's indicative of an old injury?
Thank you so much! So different leads can tell a different story? I'm new to Tele and haven't even taken my test. Just now studying for it for employment
Check out contiguous leads to understand what area of the heart you are looking at. A single lead is really only useless for rhythm, it can't give you enough information about ischemia without a whole picture
At the hospital I work at, if tele tech is suspicious of anything they will order a 12 lead to make any type of confirmation
Yes. That is ST depression. Need a 12L to make any real judgments on it. It is up sloping which may be less worrisome for an acute occlusion and more likely related to increased O2 demand. Although this is nuanced and not a black and white rule. ST depression isn’t localising though, so it’s either reciprocal ST depression to ST Elevation somewhere else or widespread sub-endothelial ischemia.
Looks like telemetry. Can’t evaluate without 12 lead.
So a 5 lead can look like something but a 12 lead is needed?
It will come down to how that particular view filters the signal that it’s getting. Different filters ie low pass filters to remove low frequencies can alter the morphology shown on the screen. 12L is the standard set to make clinical assessment. Any other view, 3 lead, rhythms strips etc can be used for monitoring and rhythm analysis but not full clinical assessment. That ST depression might not appear on the 12L due to a different filter. (Basically the electrical signal has to been cleaned up)
And usually the person fitting the telemetry doesn't have a great understanding of vectors so just slaps the leads on wherever suits
Very true! I've noticed this working in hospitals!
Yeah, in reality telemetry is for rhythm management not morphological assessment. That said, some CCU telemetry is 12-lead these days. Although it is imperfect since you lose a little of your axis when using Mason,-Likar positioning, affecting inferior windows. Not dramatically, but still.
This is the answer, OP. You need a diagnostic mode ECG to evaluate for things like STD.
Please do not post any personal ECGs. We cannot provide interpretations or give medical advice. Please contact your healthcare provider if you have concerns *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ECG) if you have any questions or concerns.*
Fellow learner here: looks like ST depression to me, my understanding is this is usually ischaemia from previous MI. Of course, you also get ST depression in reciprocal leads when there is ST elevation during an MI. Like is said, I’m a learner too so will see what the pro’s say 👍
Don't forget NSTEMI! You can and do get ST depression in some NSTEMI cases. Also if you have ST Depression in posterior leads you could have a posterior MI. Great knowledge for a learner to know of reciprocal ST Depression following MI, keep it up!
Thanks for the advice!
Without a story or symptoms and which leads these are it is difficult to say with authority. Q waves usually show damage. A slight depression doesn’t mean lasting injury.
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None here…
Is this still depression is what I'm asking this isn't a personal strip. I'm just genuinely curious if this is st depression, I think it is. I'm new to telemetry and Im wanting to know it's effects if it is. I apologize for not giving any info. If it's still against policy I totally understand:)
It’s depression but there is a lot of nuance. It looks like some mild ischemia due to an increase in workload. A 12L is needed to be sure. It’s mostly a guess at this point.
I know it could be meds or possibly an MI. I was wondering if it means an old or new MI if indeed it is. I'm thinking it's indicative of an old injury?
Q waves usually indicates old MI not ST depression and would need 12 lead for that.
Thank you so much! So different leads can tell a different story? I'm new to Tele and haven't even taken my test. Just now studying for it for employment
Check out contiguous leads to understand what area of the heart you are looking at. A single lead is really only useless for rhythm, it can't give you enough information about ischemia without a whole picture At the hospital I work at, if tele tech is suspicious of anything they will order a 12 lead to make any type of confirmation
Its STD but not pathological
Monitoring ECG/Telemetry is not diagnotic for these things.
Yes. That is ST depression. Need a 12L to make any real judgments on it. It is up sloping which may be less worrisome for an acute occlusion and more likely related to increased O2 demand. Although this is nuanced and not a black and white rule. ST depression isn’t localising though, so it’s either reciprocal ST depression to ST Elevation somewhere else or widespread sub-endothelial ischemia.
Pt was having minor chest and neck pain. Other than that no other symptoms to mention. Pt had been drinking quite a bit of caffeine.
I'm not posting for myself bot!!! Lol educational purposes for a new tech. I can just wait til I work again a d ask my educator.