Wednesday, 3 October 2012

ECG of the Week - 1st October 2012 - Interpretation

This ECG is from a 22 year old female with sudden onset severe headache.





Click to enlarge


Rate:
  • 54
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal (-14 deg)
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (80ms)
  • QT - 440-480ms (QTc Bazette ~ 420 ms)

Additional:

  • Deep T wave inversion V2-6, I, II, III, aVF
  • Positive T wave aVR
  • Positive deflection terminal portion T waves - ? TU fusion best seen precordial leads

Interpretation:

In clinical setting of severe headache and widespread T wave changes this is concerning for raised ICP, in this case ? subarachnoid haemorrhage ? intra-cranial bleed
The patient had a normal CT scan and was transferred to a tertiary center for further investigation and management of other co-morbidities.

References / Further Reading

Life in the Fast Lane

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