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.




Click to enlarge


Rate:
  • Mean ventricular rate 72 bpm
Rhythm:
  • 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
Axis:
  • Sinus complexes
    • LAD
  • PVC
    • Normal
Intervals:
  • Sinus Complexes
    • PR - Prolonged (~220ms)
    • QRS - Prolonged (180-200ms)
    • QT - 440ms
  • PVCs
    • QRS - Prolonged (140ms)
    • QT - 400ms 
Segments:

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

Interpretation:

  • 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

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