ECG of the Week: ECG of the Week - 31st March 2014

Wednesday, 2 April 2014

ECG of the Week - 31st March 2014 - Interpretation

The following is a rhythm strip from a 77yr old male. He has a history of hypertension and hypercholesterolaemia. He complained of chest pain during this ECG recording.
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Lead II Rhythm Strip - Total time 20 seconds

Rate:

~95 bpm

Rhythm:

Regular

Sinus

Lots of baseline artifact

Axis:

Unable to assess

Intervals:

PR - Normal (~200ms)

QRS - Normal (100ms)

QT - 360ms (QTc Bazette 450-460 ms)

Segments:

ST elevation <1mm

Additional:

Initiation of PVT / VF 3 seconds prior to end of rhythm strip

Short-long cycle initiation secondary to PVC

Interpretation:

PMVT/VF with QTc Prolongation

What happened ?

Pre-hospital the patient underwent successful DC cardioversion. On arrival to the Emergency Department the patient has ongoing chest pain and a further 3 episodes of PVT/VF which responded to DC cardioversion.
ECGs whilst in the Emergency Department did not show definitive ST segment changes but
the patient's medications included amlodipine which was ceased on admission.

Coronary angiogram showed:

RCA - Dominant - 30% proximal lesion
LMCA - Normal
LAD - 60% proximal
LCx - distal 80% - stented

Echo

Antero-apical hypokinesis
Preserved LV function

Following stent insertion an AICD was inserted given episode of QT prolongation and recurrent tachyarrhythmia.
In the setting of QT prolongation refractory VT/VF can be difficult to treat and urgent cardiology input in advised, in these settings amiodarone can further prolong the QT and should be avoided. Underlying causes need to be corrected including ceasing drugs known to prolong QT, correcting electrolyte abnormalities, and treating ischaemia.

References / Further Reading

National Guidelines