Wednesday, 6 August 2014

ECG of the Week - 4th August 2014 - Interpretation

This week's ECG is from an 80 yr old patient presenting with chest pain.
History of recent PPM insertion for tachy/brady syndrome.
Check out the comments on our original post here.





Click to enlarge
Rate:
  • 66 bpm
    • Mean ventricular response
Rhythm:
  • Irregular
  • Native rhythm
    • Atrial fibrillation - rate controlled
  • Intermittent V-paced complexes
    • Complexes #3,4,6,10
Axis:
  • LAD - Native complexes
Intervals:
  • Native Complexes
    • QRS - Normal (100ms)
    • QT - 400ms
  • Paced Complexes
    • QRS - Prolonged (140ms)
    • QT - 440ms
Segments:
  • Paced complexes show appropriate discordant change
Interpretation:
  • Rate controlled atrial fibrillation with intermittent v-pacing
What happened ?


The patient had serial ECG's which showed intermittent sinus rhythm and atrial fibrillation with appropriate pacemaker function.
Serial troponins were elevated consistent with a NSTEMI and the patient declined an angiogram preferring on-going medical management of her symptoms.

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.