Sunday, 3 May 2015

ECG of the Week - 27th April 2015 - Interpretation

Some old ECG's from my collection for this week. These ECG's are from an 80 yr old female who presented with pre-syncope. The three ECG's were performed over the course of an hour. Check out the comments on our original post here.


ECG 1
Click to enlarge 
Rate:
  • 54 bpm
Rhythm:
  • Irregular
  • No clear P waves
  • Single ventricular ectopic seen in leads V1-3
Axis:
  • Normal
Intervals:
  • QRS - Prolonged (120ms)
Segments:

  • ST Elevation lead aVR, V1-2
  • ST Depression leads I, II, V4-6

Additional:

  • T wave inversion leads I, aVL
  • LBBB like Morphology
    • QRS >120ms, Deep S wave leads V1-2, Broad R wave in lead I

ECG 2
Click to enlarge
Rate:
  • 48 bpm
Rhythm:
  • Irregular
  • No clear P waves
  • Single ventricular ectopic now seen in leads V4-6
Axis & Intervals




  • Unchanged
Segments:

  • ST Elevation lead aVR, V1-2
  • ST Depression leads I, II
    • Unable to comment on native activity in leads V4-6 due to only partial complex included

Additional:




  • Possible U wave in leads V2-3
  • T wave inversion leads I, aVL
  • LBBB like Morphology
    • QRS >120ms, Deep S wave leads V1-2, Broad R wave in lead I

ECG 3
Click to enlarge
Rate:
  • 78 bpm
Rhythm:
  • Irregular
  • No clear P waves
Axis & Intervals

  • Unchanged

Segments

  • ST Elevation lead aVR, V1-3
  • ST Depression leads I, II, aVL, V4-6

Additional:




  • Possible U wave in leads V2-3
  • T wave inversion leads I, aVL
  • LBBB like Morphology
    • QRS >120ms, Deep S wave leads V1-2, Broad R wave in lead I
Key Features
  • Variable rate AF
    • From bradycardia to rate controlled
  • Dynamic ST segment changes comparing ECG 3 with the others ST segment changes appear more pronounced

I don't have any further information on this case but there are a broad general list of differentials for these ECG features including:
  • Ischaemia
  • Sinus Node Dysfunction
  • Electrolyte abn
  • Drug effect especially digoxin
  • Drug toxicity including digoxin, CCB, beta-blocker
  • Endocrine – hypothyroid
  • Environmental - hypothermia
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.