Wednesday, 7 August 2013

ECG of the Week - 5th August 2013 - Interpretation

This ECG is from a 28 year old male who presented following a fall from height, 2 metres, and complained of mild left chest & arm pain. His vital signs are all normal.
Check out the original post to see a collection of excellent comments on this ECG.


Click to enlarge
Rate:
  • 90
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal (55 deg)
Intervals:
  • PR - Normal (200ms)
  • QRS - Normal (80ms)
  • QT - 320ms (QTc Bazette ~ 400 ms)
Segments:

  • PR segment depression leads I and II
  • Upsloping ST depression (minor) leads V3 and V6

Additional:

  • Abnormal R wave progression across precordial leads
  • Leads V1, V2, V5 predominantly negative QRS vector
    • Magnitude of 'negativity' in vector V2>V1>V5
  • Leads V3, V4, V6 predominately positive QRS vector

Interpretation:

  • Misplaced precordial leads
    • Likely V1 & V2 swapped and V3 & V5 swapped

The ECG was repeated with the lead misplacement corrected and was normal, sorry but I didn't keep the normal ECG for this case.
The pr segment changes were old, the patient had a normal CXR, and was subsequently discharged.

Blunt Cardiac Injury

I don't want to reinvent the wheel here so I'm simple going to point to the only guideline I could find on blunt cardiac injury, in addition to some related blog / podcast posts.

VAQ Corner

A 28yr old male presents to your ED following a fall from 2 metres.
He complains of left chest & arm pain.
His vital signs are normal.
An ECG is performed, see above.

a) Describe and interpret his ECG ? (50%)
b) Outline your risk stratification approach to blunt cardiac injury ? (50%)

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