ECG of the Week - 24th November 2014 - Interpretation

This is one of the oldest ECG's I have in my collection and as such I don't have any clinical information on the case other then it's from a 90 yr old female. 
So why do we think she ended up in the Emergency Department based on the ECG ? 
Check out the comments on our original post here.

Click to enlarge

Rate:

• ~48 bpm

Rhythm:

• Irregular
• No p waves visible

Axis:

• Normal

Intervals:

• QRS - Prolonged (~180ms)
• QT - 720ms

Segments:

• Inferior ST sagging

Additional:

• RBBB Morphology
• Osborn J waves
• Prominent U waves best seen infero-laterally
• T wave inversion leads aVR, aVL, V1-3

ECG with T, U and J waves labelled
Click to enlarge

Interpretation:

• Slow Atrial Fibrillation
• J-waves
• Prominent U waves

Differentials for this ECG

Without more clinical information it's difficult to give a firm conclusion. I think this ECG is most consistent with hypothermia but some features could be explained by drug toxicity (digoxin, CCB's, beta-blockers), electrolyte abnormalities, ischemia, sinus node dysfunction. We should be mindful in the elderly that the clinical situation is often multi-factorial and could be a combination of the above causes. Also remember hypothermia in the elderly has a multitude of potential causes including environmental, sepsis and endocrine.

New Team Member

I'd like to welcome Dr Richard McClelland to our ECG blogging team - Richard is a EM registrar in Australia planning to continue his training back in the UK.

References / Further Reading

Life in the Fast Lane

• Hypothermia

Textbook

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