Wednesday, 26 November 2014

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

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