ECG of the Week: ECG of the Week - 1st December 2014

Friday, 5 December 2014

ECG of the Week - 1st December 2014 - Interpretation

This ECG is from a 23 yr old female. She presented to the Emergency Department feeling generally unwell. She is a known Type 1 Diabetic.
Check out the comments from our original post here.

Click to enlarge

Rate:

~108 bpm

Rhythm:

Regular
Rhythm unclear
Nil clear P waves
Likely sinoventricular

Axis:

Intervals:

QRS - Prolonged (200ms)
QT - 440ms

Segments:

ST elevation leads II, aVF, aVR, V3
ST depression leads I, aVL, V1, V6

Additional:

Prominent T waves in leads II, III, aVF, aVL, V4-5
No fusion / capture beats
Absence of concordance

Interpretation:

Wide complex tachycardia

The general differentials for WCT include:

VT
SVT with BBB / aberrancy / pre-excitation
Paced rhythms
Toxins e.g. sodium channel toxicity
Do not forget Hyperkalaemia

The extent of the widening plus the clinical stem of young patient with a metabolic disorder strongly suggests hyperkalaemia as the cause, time for a quick venous gas.

What happened ?

I went back to my ECG folder to find this ECG had been donated by one of my colleagues and is over 14 yrs old. The only comment on the top of the ECG is unsurprisingly hyperkalaemia. The ECG below is also attributed to the same case and one can only assume there was interval treatment of the electrolyte and acid-base disturbance.