Friday, 21 December 2012

ECG of the Week - 24th December 2012

This ECG is from a 67 year old female.
How a look and see what you think ?

Happy Christmas to all our readers :-)

Thank you for your continued interest and support in our little corner of the #FOAM bubble

At the request of one of our commenter's I've managed to find a little more information on the clinical scenario. ECG is from a patient presenting with LIF pain and multiple episodes of vomitting and diarrhoea. History of diverticulitis only, nil regular medication.

Click to enlarge


  1. Sinus arrhythmia with U waves and possible LAE. I'm curious about the presentation of the pt.

  2. Hi,

    When the ECGs are given to me I often don't get a lot, or at times any, clinical contextor additional informatio.

    I've gone back to the orginal ECG and managed to back trace the case.

    The ECG is from a 67 yr old female whopresented with LIF pain and multiple episodes of diarrhoea & vomiting. Pst Med Hx diverticulitis.



  3. Rate: ~65 bpm
    Regularity: regular w/o ectopy
    P-waves: sinus, some notching
    PRi: 120ms
    QRSd: narrow
    Axis: normal frontal axis, early R-wave transition
    QTc: long-normal, visible U-waves, long QUi
    ST/T-waves: some scooping of ST-segments, otherwise normal

    Rhythm: normal sinus rhythm

    DDx: mild hypokalemia? Otherwise unremarkable ECG for a 67yo female

  4. Hmm...
    Multiple episodes of diarrhoea and vomiting, the latter not being entirely consistent with diverticulitis. Then again, I'm not surgically inclined...

    Having some trouble linking the ECG with the clinical history.

    Subtle Q's inferiorly and a dodgy looking T wave in III? Sometimes could be PE or evidence of something happening in that territory, current or in the past.

    I'd be interested in the clinical examination findings to see if there was any abdominal guarding or pathology, as well as a cardiorespiratory examination given this is an ECG case.

    Meh, I'm just guessing.

    My question is: Why was the ECG done? The cynic in me says there's a MBS item number for reporting ECG's but there still must have been a clinically justifiable reason for doing one.

    I don't think this patient fits the DRAC admission criteria :)

  5. Hi guys,

    I agreed with Kevy that the patient clearly doesn't require urgent DRAC intervention, give it a few more years ;-)

    I didn't see this paitent but extrapolating from the information I have, it is likely the CVS & Resp examination was unremarkable. The abdominal examination most likely revealed diffuse tenderness with guarding in the LIF & LUQ.

    Given we often deal with very undifferentiated pathology in the ED the majority of patients get ECGs as screening tests.

    In this case ECG indications could include ? evidence of arrythmia esp. AF (either secondary to intra-abod pathology or primary as in ischaemic bowel), evidence of electrolyte abnormality, drug toxicity esp. chronic digitalis with GIT symptoms (although this patient wasn't on digoxin), or ischaemic features (I've seen tombstoning STEMI present with abdo pain).

    In this case there are, as Christopher has alluded to,subtle features suggesting pathology requiring treatment these features on ECG allow prioritisation of Tx and rapid Ix, e.g. VBG rather than waiting for lab results.

    There is certainly no billing implication in an Australian, or UK, public ED for an ECG to be performed or not. I suspect this is not the case in the USA. My understanding of the funding system is that it related to completed episodes of care regardless of interventions, or investigations performed.