ECG of the Week: ECG of the Week - 13th February 2017

Wednesday, 15 February 2017

ECG of the Week - 13th February 2017 - Interpretation

This ECG is from a 91 yr old female who presented to a rural medical center, 260 km (160 miles) from the nearest tertiary hospital, complaining of weakness and difficulty standing.

ECG on presentation
Click to enlarge

Key features:

Bradycardia rate 30 bpm
Nil atrial activity visible
Normal axis

Close to -30 deg with near isoelectric lead II

Narrow QRS

Similar morphology to old ECG below

Late R wave transition
T wave inversion leads V2-3

New compared with old ECG

ECG from 1 year prior
Click to enlarge

Key features:

Sinus rhythm, rate 60 bpm
Left axis deviation
PR prolongation
QRS narrow
Voltage criteria for LVH in lead aVL

Interpretation:

Junctional bradycardia

New T wave changes
Nil evidence atrial activity

There are broad causes for the clinical picture and new ECG changes that need to be considered in these cases:

New anterior T wave change but nil history of chest pain
No significant ST segment changes

Structural disease

Cardiomyopathy
Valvular disease

Electrolyte abnormality

Hypokalaemia - can cause ECG changes and clinical weakness
Hyperkalaemia - can cause almost any ECG abnormality

Drug toxicity

Consider digoxin, calcium channel blockers, beta blockers
Usually chronic toxicity in the elderly but can be acute
May be seen with worsening of other co-morbidities especially renal failure / chronic kidney disease