Wednesday, 30 January 2013

ECG of the Week - 28th January 2013 - Interpretation


This week's ECG was kindly donated by @UnaNicI. It's from a 45 year old male.
 
 
 
 
Click to enlarge
 
Rate:
  • ~66 bpm
Rhythm:
  • Sinus
  • Sinus Arrhythmia - minor
Axis:
  • Normal (+30 deg)
Intervals:
  • PR - Normal (~120ms)
  • QRS - Normal (80-100ms)
  • QT - 400ms (QTc Bazette ~ 410 ms)
Segments:
  • Up sloping ST elevation V2
  • No ST depression
Additional:
  • T wave inversion V1- V6, I, aVL
    • T Inversion V2 - V4 exceptionally deep
    • Biphasic T wave V2 - V6
  • Variable QRS amplitude in 1st, 4th, and 8th complexes without significant baseline disturbance

Differentials:

  • LAD Lesions- Wellen's
  • Myocarditis
  • Takotsubo's Cardiomyopathy
  • Sympathomimetic use / toxicity
  • CNS Lesion - 'Cerebral' T waves
  •  Hypertrophic Cardiomyopathy
Dr Razak has recommended a nice review paper on ST-segment depression and T wave inversion, by EB Hanna and DL Glancy, for those of you who want to read further on this topic, the full text can be found here.

References / Further Reading
 
Life in the Fast Lane

  • Hypertrophic cardiomyopathy here
  • Myocarditis here
  • Wellen's here
  • Takotsubo's cardiomyopathy here
Article
  • Hanna EB, Glancy DL. ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med. 2011 Jun;78(6):404-14. PMID: 21632912 Full text here
 Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005. 21632912