Wednesday, 30 April 2014

ECG of the Week - 28th April 2014 - Interpretation

This week's ECG is from a 75 yr old female with a histroy of ischaemia heart disease.
She presented complaining of palpitations and dysponea. Clinical examination finding were consistent with cardiac failure.
Check out the comments from our original post here.

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  • Mean ventricular rate 72 bpm
  • Regular atrial activity ~75 bpm
  • Repeating pattern
  • Sinus complex --> sinus complex --> premature ventricular complex (PVC)
  • see P waves buried in the PVC best seen lead I and lead V2
  • Sinus complexes
    • LAD
  • PVC
    • Normal
  • Sinus Complexes
    • PR - Prolonged (~220ms)
    • QRS - Prolonged (180-200ms)
    • QT - 440ms
  • PVCs
    • QRS - Prolonged (140ms)
    • QT - 400ms 

  • Appropriate discordant ST segment and T wave changes
    • Sgarbossa criteria negative


  • LBBB
  • 1st Degree AV block
  • Regular PVC's
    • Trigeminy

What happened ?

The majority of the patient's ECG changes were pre-existing, only the frequent PVCs were new.
The patient had a normal potassium and equivocal troponin.
Previous echo, ~1yr prior, showed:

  • LV Dilation with inferolateral akinesis
  • Severe systolic impairment
  • Severe mitral regurgitation with possible chordae rupture.
  • LA dilation
  • Severe pulmonary hypertension
The patient has significant other co-morbidites and was unsuitable was invasive cardiac intervention and was therefore for medical managment. This episode of cardiac failure was treated with fluid restriction, diuretic increase, and medication maximisation.

References / Further Reading

Life in the Fast Lane

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

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