Wednesday, 29 October 2014

ECG of the Week - 27th October 2014 - Interpretation

This ECG is from a 70 yr old male who presented complaining of dysponea and cough.
I'm sorry for the quality of this ECG, it's a copy of a copy which has then been scanned. I've elected to include it on the blog as I think it's a nice ECG example despite the poor quality.
Check out the comments from our original post here.




Click to enlarge
Rate:
  • ~84 bpm
Rhythm:
  • Irregular
  • Sinus rhythm
  • Complexes #5 & #7 premature complexes (atrial vs junctional)
    • Associated pause following
Axis:
  • Right axis deviation
Intervals:
  • PR - Normal (160ms)
  • QRS - Normal (80-100ms)
  • QT - 360ms 
Segments:

  • No ST changes

Additional:
  • Lead I & aVL inverted P wave, negative QRS and negative T wave                        
  • Lead aVR and V1 noticeably different morphologies
  • Lead V2 obscured by artifact
  • Normal R wave progression


Interpretation:

  • Sinus rhythm with premature complexes
  • Lead reversal - RA / LA
    • Inverted lead I
    • Leads II & III switch places
    • Leads aVR & aVL switch places
Whilst you get a similar picture with dextrocardia, the heart rather than the leads being reversed, this should also result in precordial voltage changes as seen in our ECG from 17th Feb 2014.


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.