ECG of the Week: ECG of the Week - 19th May 2014

Wednesday 21 May 2014

ECG of the Week - 19th May 2014 - Interpretation

This ECG is from a 40 yr old female with sepsis. The patient was intubated and requiring vasopressor support. Prior to this illness the patient was fit and well.
Thanks to Dr Nat for sharing this ECG.
Check out the comments on our original post here.

Click to enlarge

Rate:

90 bpm

Rhythm:

Regular atrial and ventricular activity
Complexes #1-10 independent atrial and ventricular pacemakers

Variable relationship between p wave and QRS complexes

Complexes #11-15 sinus

Fixed pr interval with subtle change in associated qrs morphology - appreciated in lead II rhythm strip

Axis:

Normal

Intervals:

PR - Variable relationship in complexes #1-10 between p waves and QRS complexes. Complexes #11-15 fixed pr relationship with normal pr interval (ms)

QRS - Complexes #1-10 have broader width than complexes #11-15

Segments:

Minor ST depression V2

Additional:

T wave inversion lead III

Interpretation:

Isorhythmic dissociation

Independent activation of atrial and ventricles - complexes #1-10
Atrial and ventricular rates similar, ~90bpm
Restoration of sinus rhythm at end of ECG - complexes #11-15
Reflects SA node and junctional pacemakers with near identical rates
Requires no intervention

What happened ?

The patient made an uneventful recovery from their sepsis.
Nil evidence of myocardial ischaemia with normal ECHO.

Some VAQ question thoughts

In this week's VAQ we had a patient deteriorate rapidly whilst ventilated.
Check out two great case based discussions from Chris Nickson of Life in the Fast Lane for some pointers on how to approach this situation.

References / Further Reading

Amal Mattu ECG Videos