Wednesday, 27 September 2017

ECG of the Week - 25th September 2017 - Interpretation

The following ECG is from a 60 yr old female who was competing in a triathlon when she became short of breath. She was found to be hypothermic (32 C / 89.6 F) at the scene but normothermic on arrival to the Emergency Department (36 C/ 96.8 F)





Click to enlarge

Rate:
  • 78 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal
  • QRS - Normal
  • QT - 440ms (QTc Bazette 465 ms)
Additional:
  • ST Elevation (1mm) leads V1-3
  • No ST depression
  • T wave inversion leads I, aVL, V1-6
Interpretation:
  • Features suggestive of ACS
    • Pain-free patient on arrival to ED
    • Only complained of dysponea
  • DDx:
    • ? Reperfusion / Wellen's
    • ? Cardiomyopathy
What happened ?

Following urgent cardiology consult the patient was taken for angiography.
There was no evidence of vessel disease but appearance was typical for Takotsubo cardiomyopathy likely secondary to exertional stress from triathlon.


What are the potential complications of endurance sports ?
  • Injury
  • Rhabdomyolysis
  • Dehydration
  • Acute renal failure
  • Myocardial strain 
    • Studies have shown raised troponin's in marathon runners
  • ACS
  • Environmental illness
    • Hypothermia 
    • Hyperthermia
  • Hyponatraemia
    • SIADH
    • Water ingestion
  • Hypoglycaemia
  • Takotsubo
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.