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
Rate:
  • 36
Rhythm:
  • 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
Axis:
  • RAD
Intervals:
  • PR - Nil visible p waves
  • QRS - Prolonged (120-140ms)
  • QT - 400ms
Segments:
  • ST Elevation leads II, III, aVF
  • ST Depression leads aVL, V1-5
Additional:
  • 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


Interpretation:

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