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- 54 bpm
- Sinus Rhythm
- PR - Normal (~120ms)
- QRS - Normal
- QT - 420ms
- ST Elevation leads aVR, V1-2
- ST Depression leads II, aVF, V4-6
- Deep T wave inversion leads V2-6
- Terminal positive deflection to T wave in these leads ?U wave
- T wave inversion leads I, II, aVF
- Massive R waves in all precordial leads
- Extensive T wave abnormalities with massive precordial complexes
- Electrical injury related
- Incidental finding of cardiomyopathy ( ECG pattern favours apical variant)
On history review the patient had no history of loss of consciousness, syncope, palpitations or chest pain related to his presenting injury. There was a positive family history of cardiomyopathy in a close relative but no history of sudden cardiac death.
The patient was admitted under cardiology for further investigation.
The patient had negative serial troponins and underwent angiogram which showed:
- Normal coronary arteries
- Normal LV function
- ? Apical hypertrophy
- Normal LV cavity size and function
- Asymmetric distribution of left ventricular hypertrophy affecting the apical LV region
You can read more about apical hypertrophic cardiomyopathy in the links below:
- Life in the Fast Lane - Hypertrophic Cardiomyopathy
- Madias JE. Electrocardiogram in apical hypertrophic cardiomyopathy with a speculation as to the mechanism of its features. Neth Heart J. 2013 Jun;21(6):268-71. PMID:23686564
- Yıldırım MN, Selçoki Y, Eryonucu B. Apical Hypertrophic Cardiomyopathy. Eur J Gen Med 2010;7(2):206-209
What about the electrocution ?
There are a wide variety of ECG features that have been reported in the setting of electrocution including:
- Arrhythmia - AF, VT, VF
- AV Block - all types
- ST / T wave changes
- QRS Abnormality
- Bailey, Benoit, Pierre Gaudreault, and Robert L Thivierge. “Cardiac Monitoring of High‐risk Patients after an Electrical Injury: A Prospective Multicentre Study.” Emergency Medicine Journal : EMJ 24.5 (2007): 348–352. PMC. Web. 5 Apr. 2017.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.