Wednesday, 25 January 2017

ECG of the Week - 23rd January 2016 - Interpretation

The following ECG is from a 86yr old male who presented to the Emergency Department following an episode of syncope.



Click to enlarge

Rate:
  • Ventricular rate 48 bpm
  • Atrial rate 72 bpm
Rhythm:
  • Repeating pattern
    • Atrial activity with pr prolongation ~330ms
    • Sinus ventricular beat
    • Progressive PR prolongation ~440ms
    • Narrow QRS
      • Junctional escape vs sinus beat
    • Notching in terminal QRS likely superimposed P wave
    • Pause
Axis:
  • Normal
Intervals:
  • PR - Progressive prolongation
  • QRS - Normal
Segments:
  • ST Depression II, aVF, V4-6
Additional:
  • Prominent anterior T waves
  • Broad notched P wave in lead II
    • Left atrial abnormality
What happened ?

The patient was admitted for cardiac monitoring and cardiology review. Continuous cardiac monitoring showed intermittent 2nd Degree Wenckebach AV Block and bradycardia. The patient was offered a PPM and declined. There were no identifiable reversible cause including drug toxicity, electrolyte abnormality, myocarditis or ACS.

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.