Wednesday, 19 April 2017

ECG of the Week - 17th April 2017 - Interpretation

This ECG is from a 79yr old male who presented to the Emergency Department with central abdominal pain secondary to an incarcerated hernia. A pre-op ECG was performed and is below.



Click to enlarge

Rate:

  • 66 bpm
    Rhythm:
    • Regular
    • Ventricular paced rhythm
    • Pacing spikes best seen in lead V2
    • Evidence of possible native atrial activity
      Axis:
      • Normal
      Intervals:
      • QRS - Prolonged (160ms)
      Segments / Additional:
      • Typical LBBB morphology
        • Discordant ST / T wave changes
        • Magnitude of ST change is appropriate for QRS voltages 
      Interpretation:
      • Ventricular paced rhythm
        • Nil features to suggest pacemaker problem
        • 100% Capture
        • Nil evidence of sensing failure
        • Sgarbossa / Modified Sgarbossa negative
      The pre-operative assessment of a the patient with an implantable device is outside the scope of Emergency Medicine practice but the following articles have a good overview of how to approach the peri-operative management of patient's with pacemakers:
        
      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.