Wednesday, 28 September 2016

ECG of the Week - 26th September 2016 - Interpretation

The following ECG is from a 61 yr old male who presented confused having been found on the floor. He has a past medical history of gout and Parkinson's. He is unable to give a list of his medications.



Click to enlarge

Rate:
  • 48 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Prolonged(~210ms)
  • QRS - Normal (80-100ms)
  • QT - 480ms (QTc Bazette 430 ms)
Segments:

  • Nil abnormalities

Additional:

  • Osborne / J waves best seen in leads V5-6
  • Baseline artifact
    • ? Parkinson's tremor
    • ? Shivering artifact
  • Completely inverted lead III
    • Negative P, QRS & T
    • Likely LA/LL Reversal
      • Results in inverted III, switch of I & II and switch of aVL & aVF
  • Low voltage ECG with the exception of V6

Interpretation:

Changes consistent with hypothermia

  • Bradycardia
  • 1st Degree AV block
  • J waves

What happened ?

The patient's core temperature was 31.1 degrees Celsius. 

There are multiple potential causes of hypothermia including:

  • Cold water immersion
  • Cold / wet / windy environments
  • Exhaustion
  • Excessive activity e.g. marathon runners
  • Head injury
  • Trauma inc. entrapment
  • Immobility +/- trauma
  • Major burns
  • Drugs inc. sedatives, alcohol, phenothiazines
  • CVA
  • Parkinson's disease
  • Sepsis
  • Endocrine inc. adrenal insufficiency, hypothyroid, hypoglycaemia
  • Malnutrition
  • Iatrogenic inc. massive transfusion, fluid resuscitation, exposure
  • Age - elderly and neonates



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.