Wednesday, 11 July 2012

ECG of the Week - 9th July 2012 - Interpretation

This weeks ECG was from a 25 year old female.


Click to enlarge

Rate:
  • ~125
Rhythm:
  • Sinus Arrhythmia

Axis:
  • Right Axis Deviation (~120 deg)
Intervals:
  • PR - Normal (~120ms)
  • QRS - Normal (80ms)
  • QT - 300ms (QTc Bazette ~ 390 ms)
Segments:
  • Slight ST Depression Leads II, III, aVF

Additional:
  • P wave Inversion Leads I, aVL


Interpretation:

  • Sinus Tachycardia

  • RA / LA Lead Reversal
    • Leads aVR / aVL swap places
    • Lead I becomes inverted
    • Leads II / III swap places
    • Resultant RAD, p inversion I & aVL

This patient had the right arm and left arm electrodes reversed and hyperthyroidism causing her tachycardia

References / Further Reading

Life in the Fast Lane

  • Limb Lead Reversals here
  • Right Axis Deviation here
  • ECG in hyperthyroidism here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.