Wednesday, 24 December 2014

ECG of the Week - 22nd December 2014 - Interpretation

I'd like to wish all our readers and blogging team a Happy Christmas.

This week's ECG is from a 36yr old male. He presented to the Emergency Department with a non-cardiac issue but an ECG was performed due to a pre-existing cardiac history.
Thanks to Dr Fiona Beattie was sharing this ECG case.
Check out the comments from our original post here.


Click to enlarge
Rate:
  • ~115 bpm
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (100ms)
  • QT - 320ms
Segments:

  • ST elevation leads aVR (<1mm), V1 (1mm), V2 (2mm)
  • ST depression lead I

Additional:

  • Biphasic T wave leads aVF & V3
  • T wave inversion leads I, II, aVL and deep inversion leads V4-6
  • Voltage criteria for LVH
    • S V2 (25mm) + R V6 (20mm)
  • R wave peak time in leads V5 & V6 ~60ms
  • P waves wide with deep terminal deflection in lead V1 with nitching in lead II

Interpretation:

  • Sinus tachycardia
  • ECG features for:
    • LVH
    • LAE
  • Deep antero-lateral T wave inversion

Broad differentials

These ECG features could be seen in a wide range of conditions and include:

  • Ischaemia
  • Myocarditis
  • Acid-base / electrolyte disturbance
  • Raised ICP

What about this patient ?

The key to interpretation of any ECG, or any test for that matter, is looking at the test and then taking it back to the patient in question. In this case we have a young male with no acute cardiac complaint, i.e. nil chest pain, dysponea, and a known cardiac condition. Given these factors the most likely cause is apical hypertrophic cardiomyopathy given the absence of Q waves and deep T wave inversion in the precordial leads, this patient did in fact have known apical hypertrophic cardiomyopathy.

You can read more about apical hypertrophic cardiomyopathy in the links below:




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.