Wednesday, 18 April 2012

ECG of the Week - 16th April 2012 - Interpretation

A cold ECG for interpretation this week with no clinical information.






Click to enlarge

Rate:
  • 96
Rhythm:
  • Regularly irregular
  • Alternating sinus & premature ventricular complex (PVC)

Axis:
  • Normal (50 deg)
Intervals:
  • PR - Short (~80ms)
  • QRS - Sinus complex - normal (80ms)
  • QRS - PVC - prolonged (160ms)
  • QT - 360ms
Segments:
  • Sinus Complexes - ST elevation V3
  • PVCs - ST elevation aVR, aVL,V1-3
  • PVCs - ST depression II, III, aVF, V4-6

Additional:
  • RSR' Pattern V1
  • LVH - difficult to see but S V1 + R V5 likely >35mm 
  • PVCs - T inversion II, III, aVF, V4-6
  • PVCs - dominant R wave laterally

Interpretation:
  • Bigeminy
  • PVCs - LBBB Morpholgy & Appropriate ST segement & T wave discordance
  • Short pr

Causes
  • Idiopathic
  • Ischaemia
  • Electrolyte abnormalities
  • Drugs
  • Digitalis Toxicity


References / Further Reading

Life in the Fast Lane

  • Left Ventricular Hypertrophy here 
  • Premature Ventricular Complexes here
eMedicine
  • Premature Ventricular Complexes here

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.