Wednesday, 27 February 2013

ECG of the Week - 25th February 2013 - Interpretation


No clinical information on this one.


 

 

 
Click to enlarge

Rate:
  • 42
Rhythm:
  • Regular ventricular complexes
  • Irregular atrial activity
  • Complexes 3 & 4 sinus
Axis:
  • LAD (-50 deg)
Intervals:
  • PR - Normal (~180-200ms) for 3rd & 4th Complexes only
  • QRS - Prolonged (~120ms)
  • QT - 720ms (QTc Bazette ~ 600 ms)
Segments:
  • Slight down sloping ST Depression V5-6
Additional:
  • T wave inversion I, aVL, V1, V3-6
  • QRS Morphology RBBB Pattern
  • Differing QRS Morphology between complexes 1-2,5-7 and complexes 3-4
  • Difficult to map atrial activity given relative low voltage p wave
  • R wave progression abnormal across precordial leads
    • ? V2 misplacement - terminal deflection QRS >> than V1&2 with positive T wave
Interpretation:
  • Intermittent trifasicular block likely complete
    • Bifasicular block with variable sinus capture & high grade AV block

References / Further Reading

 
Life in the Fast Lane

 
  • Trifasicular Block here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.