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:
  • LAD
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.

Click to enlarge
Dr Ken Grauer shares a very similar case to this one on his blog that I'd recommend our readers check out:



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.