Wednesday, 26 December 2012

ECG of the Week - 24th December 2012 - Interpretation

This ECG is from a 67 year old female.
Presenting with LIF pain and multiple episodes of vomitting and diarrhoea.

History of diverticulitis only, nil regular medication


Click to enlarge


Rate:
  • ~66
Rhythm:
  • Sinus rhythm
  • Sinus arrythmia 
Axis:
  • Normal (~+60 deg)
Intervals:
  • PR - Normal (~140ms)
  • QRS - Normal (80-100ms)
  • QT - 440ms (QTc Bazette ~ 425 ms)
Segments:
  • ST Elevation Leads aVR (~1mm), V1 (subtle)
  • ST Depression Leads I, II, III, aVF, V3-6

Additional:
  • Early R transition precordial Leads
  • U waves Leads II, III, aVF, V2-6
  • Notching P wave best seen lead II, although duration appears <110ms
Interpretation:
  • Non-specific ST segment changes with widespread U waves
  • Consider
    • Ischaemia
    • Hypokalaemia
 The patient had no chest pain, and serum potassium was 2.9 mmol/L

References / Further Reading
 
Life in the Fast Lane
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.