Wednesday, 1 May 2013

ECG of the Week - 29th April 2013 - Interpretation


This ECG is from a 47 year old female presenting with palpitations of 3 hours duration.




Click to enlarge

Rate:
  • 156 bpm mean rate
    • Varies between ~135 - 185 bpm
Rhythm:
  • Irregularly irregular
  • Nil p waves
Axis:
  • Normal (+45 deg)
Intervals:
  • PR - Nil p waves visible
  • QRS - Normal (60-80 ms)
  • QT - 240-280ms (QTc Bazette ~ 360-470 ms)
Segments:
  • ST Elevation lead aVR (1mm)
  • ST Depression leads I, II, III, aVF, V4-6
Interpretation:
  • Atrial Fibrillation with rapid ventricular response
    • a.k.a 'Fast AF'
    • Inferolateral ischaemic changes
      • ? Rate related
VAQ Corner

Our VAQ style question for this ECG was :

47 year old female presents complaining of palpitations onset 3 hours age. She denies chest pain and is not short of breath. She has no prior medical history. Blood pressure is 120/75.

Her ECG is above.


a) Describe and interpret her ECG (30%)

b) Outline your management options (70%)

Management Options in Atrial Fibrillation

There are several considerations in the management of AF which include:

  • Rate vs. rhythm control
    • Electrical vs Chemical rhythm control
  • Anti-coagulation
    • Risk vs Benefit
    • Drug to use
  • ? Underlying precipitant
    • Infection / ischaemia / structural / endocrine / metabolic etc.
  • Follow-up / disposition
  • Ablation suitability

Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including:


AF Related Calculators (links to MDCalc)



References / Further Reading

Life in the Fast Lane

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