Thursday, 12 November 2015

ECG of the Week - 9th November 2015 - Interpretation

This ECG is from a 55 yr old male who presents with several weeks of intermittent dizziness. He has an implanted loop recorder (ILR) in-situ and is under cardiological investigation for these episodes.

Click to enlarge
Rate:
  • 54 bpm
Rhythm:
  • Subtle irregularity
Axis:
  • Normal
Intervals:
  • PR - Short (~120ms)
  • QRS - Normal (90ms)
  • QT - 460ms (QTc Bazette 440 ms)
Segments:
  • No significant change
Additional:
  • U waves V2-3
  • Normal P wave axis
  • No delta waves
  • Note artifactual 'spike' preceding last p wave 
Interpretation:

  • Sinus bradycardia
  • Short pr without features of pre-excitation or retrograde p wave conduction

What happened ?

The patient's ILR revealed multiple episodes of symptomatic junctional bradycardia and he underwent an uneventful PPM insertion. I'm certainly encountering more patients with ILS's in-situ and it's worth reading the following eMedicine summary on these devices:

eMedicine

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.