I was shown this ECG without any information. What do you think?

I was shown this ECG; " Steve, what do you think of this? " :What is going on?I said: " This is pulse tapping artifact and a long QT "  Why did I say that?Whenever you see a very bizarre EKG, you should think about pulse tapping artifact.  This is when one of the limb lead electrodes is placed over an artery, especially when placed over a dialysis fistula.When you suspect this, your next task is look for the one lead among leads I, II, and III which is NOT bizarre.  Lead I in this ECG is not bizarre [though it does show a very long QT (or QU)].Leads I is formed by the right arm and left arm electrode.Lead II by the right arm and left leg electrodeLead III by the left arm and left leg electrodeSo if lead I isnot bizarre (as in this case), then the electrodes that areNOT affected are the right and left arm.Thus,theleft leg electrode is placed over an artery." Augmented leads " (aVR, aVL, aVF): these are all dependent on Wilson ' s Central Terminal, which is the average of leads I, II, and III.Precordial leads: these use the limb leads for their grounding, so they are all also affected by one limb lead that is aberrant.Therefore, as many as 11 of the 12 leads can look bizarre.Solution: repeat the ECG, but move the left leg electrode.Pulse tapping artifact was not recognized.The patient had come to the ED for SOB, but without any chest pain.  He has 3 weeks of progressive fatigue and weakness.  He had a 10 pound weight loss.He was moved to ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs