Wednesday, 13 February 2013

ECG of the Week - 11th February 2013 - Interpretation


Part two of the trilogy.
This is the next ECG in the series following on from last week's ECG.
So we've started our patient on amiodarone and this happens.
 
 
 
 
Click to enlarge
 
 


Rate:
  • 60
Rhythm:
  • Regular
  • Atrial Paced

Axis:
  • Normal (-5 deg)
Intervals:
  • PR - Prolonged (~320ms)
  • QRS - Prolonged (140 - 160 ms)
  • QT - 480ms (QTc same as ventricular rate 60 bpm - QT = QTc)
Segments:
  • ST Elevation aVR, V1 (~1mm)
  • ST Depression I, II, aVL, V6
  • All changes discordant with QRS complex
 
Additional:
  • T Wave Inversion I, II,aVL, V5-6
  • Changes discordant with QRS complex except V5
  • LBBB Morphology
Interpretation:
  • Atrial Paced Rhythm
  • LBBB
    • Discordant T wave and ST changes
  • 1st Degree AV Block
 
As Christopher has mentioned the 1st degree AV block must be dependent on the PPM settings as there is no ventricular pacing, therefore threshold for ventricular pacing must be greater than 320ms.


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