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

• Lead reversals
• Premature atrial complex
• Premature junctional complex
• Dextrocardia

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.