Saturday, 23 May 2015

ECG of the Week - 18th May 2015 - Interpretation

This ECG is from a 65yr old male. He presented to the Emergency Department feeling generally unwell for 1 week with subjective fevers and night sweats. He had episodic dysponea and myalgia. He denied any chest pain during this illness. He had a previous episode of paroxysmal atrial fibrillation.
He was afebrile at presentation with a blood pressure of 85mmHg systolic.
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Rate:
  • 132 bpm
Rhythm:
  • Atrial fibrillation
    • Irregular rhythm
    • Fibrillatory waves visible in leads V1-2
Axis:
  • Normal
Intervals:
  • QRS - Normal (80ms)
Segments:

  • ST Elevation leads I, II, aVL, aVF, V1-6
  • ST Depression lead aVR
Interpretation:
  • Atrial Fibrillation with rapid ventricular response
  • Diffuse ST segment elevation
DDx
    • Pericarditis
    • Myocarditis
    • ACS
What happened ?

The patient had an urgent echo which showed no significant regional wall motion abnormality or pericardial effusion. 

He was investigated and treated for potential sepsis, malignancy, auto-immune disease and vasculitis. Further investigation revealed an OM1 stenosis but this was not felt to be a culprit lesion.

The final diagnosis was one of pneumonia with SIRS and a myo-pericarditis.


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.