Tuesday, 26 July 2016

ECG of the Week - 25th July 2016 - Interpretation

This ECG is from a 50 yr old female who presents complaining of chest pain with associated epigastric pain and vomiting. She is on a NOAC for a prior PE.

 
 
Click to enlarge
 

Rate:
  • 78 bpm
Rhythm:
  • Sinus arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Normal (120ms)
  • QRS - Normal (80ms)
  • QT - 420ms (QTc Bazette 480 ms)
Segments:
  • Subtle ST depression in leads II, III, aVF
Additional:
  • Baseline artefact
  • T wave inversion leads V1-4
Interpretation:
  • Concern was ACS with Wellen's pattern
What happened ? The patient was admitted under the cardiology team. She had a complicated in-patient stay due to several episodes of hematemesis secondary to a Mallory-Weiss tear. Her ECG during this time normalised with negative serial biomarkers, nil significant electrolyte abnormal, nil haemoglobin drop or period of cardiovascular instability. An echo and coronary angiogram were both normal. I'm at a loss to explain the dynamic ECG changes and wonder whether they represent a period of cardiac demand ischaemia / stress response or vasospasm.
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.