Wednesday, 12 December 2012

ECG of the Week - 10th December 2012 - Interpretation

This ECG is from a 69 year old male.
Have a look and think about what is going on, and what are you going to do ?
 
 
 
 
 
 
Click to enlarge
Rate:
  • Ventricular Rate 42 bpm
Rhythm:
  • Regular
  • Nil visible p waves

Axis:
  • Indeterminate
    • QRS Complexes in limb leads barely visible
Intervals:
  • PR - Nil p visible
  • QRS - Prolonged (200ms)
  • QT - 640ms (QTc Bazette ~ 510 ms)
Segments:
  • Slight ST Depression V2,3
  • Slight ST Elevation II, III, aVF
 
Additional:
  • T Inversion aVL, aVR, V1-3, ?? V4-5
  • Prominent T waves inferior leads
    • T wave amplitude >>> QRS amplitude
  • Low voltage
Differentials:
  • Hyperkalaemia
  • Toxic Drug Ingestion
  • ? Cause of QT Prolongation
What happened ?
  • Unfortunately I don't have any information regarding the presentation or subsequent management
  • I do know that the patient's potasssium was >8.5 mmol/L !


References / Further Reading
 
Life in the Fast Lane
  •  Hyperkalaemia here
  • QT Interval here
  • Case Study  Management Overview of Hyperkalaemia here
EMCrit
  • Hyperkalaemia Podcast here
Dr Smith's ECG Blog
  • Hyperkalaemia & VT A Case Review here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.