ECG of the Week - 2nd November 2015 - Interpretation

The following ECG is from a 66 yr old female who presented to the Emergency Department complaining of palpitations. Her BP, RR, Sats and conscious level are all normal.

Click to enlarge

Rate:

• 192 bpm

Rhythm:

• Regular

Axis:

• LAD

Intervals:

• QRS - Prolonged (120ms)

Segments:

• Discordant ST and T wave changes

 Additional:

• Typical LBBB morphology

Interpretation:

• Wide complex tachycardia
• DDx:
• VT
• SVT with aberrancy
• SVT with pre-exisiting BBB

Features favoring VT:

• Patient's age

Features favoring SVT:

• Typical LBBB morphology
• No capture / fusion beats
• No concordance
• No extreme axis

In the stable patient it is not unreasonable to trial chemical cardioversion initially prior to DC cardioversion.

The patient was treated with bolus iv adensoine with reversion to sinus rhythm.

Post reversion ECG below:

Click to enlarge

Note persisting typical LBBB morphology.

The patient underwent coronary angiography with showed mild disease in the LAD, RCA and LCx.

References / Further Reading

Life in the Fast Lane

• Left Bundle Branch Block
• SVT vs VT

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.