Wednesday, 22 May 2013

ECG of the Week - 20th May 2013 - Interpretation


This ECG is from a 64 year old male. 
Presented following multiple episodes of syncope.




Click to enlarge

Rate:
  • ~42 bpm mean ventricular rate
Rhythm:
  • Irregular
  • Junctional escape rhythm 
    • Complexes number 1, 3, 4, 5
    • Rate ~ 36 bpm
  • Sinus 
    • Complexes number 2, 6, 7
Axis:
  • Normal (~70 deg)
Intervals:
  • PR - Upper limit normal where present (~200ms)
  • QRS - Normal (100ms)
  • QT - 520ms
Segments:

  • ST Sagging leads II,III,aVF,V5-6

Additional:
  • T wave notching in leads V1-3 in 5th complex likely secondary to lead transition
  • Biphasic T wave V1
  • P waves broad & notched
Interpretation:
  • Intermittent sinus arrest with junctional escape rhythm

What happened ?

This ECG was captured during a symptomatic episode of presyncope. 
The patient then spontaneously reverted to sinus rhythm after a few minutes.
His beta-blocker was ceased and he was transferred for PPM insertion.

VAQ Corner

A 64 year old male presents to your ED following an episode of syncope.
He complains of feeling lighted. 
BP 105/60 RR 18 Sats 96% Room Air

a) Describe & interpret his ECG (50%)
b) Outline your management (50%)

References / Further Reading

Life in the Fast Lane

  • Sinoatrial exit block here
  • Sick Sinus Syndrome here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.