Wednesday, 20 August 2014

ECG of the Week - 18th August 2014 - Interpretation

This ECG is from a 25 yr old male presenting with 3 days of sharp central chest pain.

Check out the comments on our original post here.


Click to enlarge
Rate:
  • 110 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (160ms)
  • QRS - Normal (80ms)
  • QT - 300ms (QTc Bazette 410 ms)
Segments:
  • Widespread ST elevation leads I, II, III, aVF, V2-6
    • Concave morphology
  • ST Depression lead aVR
Additional:
  • PR depression leads I, II, III, aVF, V4-6
  • PR elevation lead aVR
  • Down-sloping T-P segment best seen in lead II
Interpretation:
  • Pericarditis 
  • Note sinus tachycardia - ? effusion

What happened ?

The patient was admitted under the cardiology team. Blood tests showed a negative troponin but raised inflammatory markers and D-dimer. A subsequent CTPA showed a pericardial effusion and the patient underwent pericardiocentesis for a large effusion, total drainage of ~900mls of fluid ! 
The ultimate diagnosis was of viral pericarditis complicated by pericardial effusion.

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.