Wednesday, 26 March 2014

ECG of the Week - 24th March 2014 - Interpretation

Another old case from my collection. I don't have any clinical information on the patient or clinical presentation.
Check out the comments on our original post here.

Click to enlarge
  • 36
  • Complexes 1-5
    • Regular
    • R-R Interval ~1500ms 
    • Followed by pause
  • Complex 6
    • Occurs ~2600ms following complex 5
      • Less than 2x preceding R-R interval
  • No p waves visible
  • RAD
  • PR - Nil visible p waves
  • QRS - Prolonged (120-140ms)
  • QT - 400ms
  • ST Elevation leads II, III, aVF
  • ST Depression leads aVL, V1-5
  • T inversion leads II, III, aVF
  • Artifact along baseline
  • Wandering of baseline prior to 3rd complex and after 6th complex
  • ? Pacing spike following 2nd complex likely artifact as nil further evidence of PPM activity


Differentials for these ECG features may pending on the clinical scenario and patient factors but broadly include:

  • Acute inferior +/- posterior MI
  • Hyperkalaemia - broad, irregular complexes
  • Drug toxicity - sodium channel blockade, digoxin
  • Environmental - hypothermia
  • CNS lesion - bleed, SOL, raised ICP

References / Further Reading

Life in the Fast Lane

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