Wednesday, 6 September 2017

ECG of the Week - 4th September 2017 - Interpretation

This ECG is from a 43 yr old male with chronic severe hypertension.





Click to enlarge
Rate:
  • 132 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal (-33 deg)
Intervals:
  • PR - Normal (~180ms)
  • QRS - Normal (100ms)
Additional:
  • Voltage criteria LVH
    • S V1 + R V5 = 35mm
  • Non-voltage criteria LVH
    • ST Depression V5-6 with T inversion
  • Features suggesting additional RVH
    • Deep S wave V5
    • Biphasic high-voltage complexes V4-5
  • Features of left atrial abnormality
    • Wide and deep P waves in lead V1
    • Notching of p wave in lead II
  • Features of right atrial abnormality
    • Tall P wave in lead II
Interpretation:
  • Sinus tachycardia
  • Features suggestive of four chamber enlargement
Note the ECG is poorly sensitive in detecting chamber enlargement and the terminology relating to p wave morphology now refers to atrial abnormality rather than atrial enlargement. 

Causes of Hypertension
  • Primary / Essential Hypertension
  • Secondary
    • Renal causes
      • Polycystic kidney disease
      • Chronic kidney disease
      • Urinary tract obstruction
      • Renin-producing tumor
      • Liddle syndrome
      • Reno-vascular disease
    • Vascular
      • Coarctation of aorta
      • Vasculitis
      • Collagen vascular disease
    • Endocrine
      • Primary hyperaldosteronism
      • Cushing syndrome
      • Pheochromocytoma
      • Congenital adrenal hyperplasia
      • Hyperthyroidism and hypothyroidism
      • Hypercalcemia
      • Hyperparathyroidism
      • Acromegaly
    • Neurogenic
      • Brain tumor
      • Autonomic dysfunction
      • Sleep apnea
      • Intracranial hypertension
    • Drugs and toxins
      • NSAIDs
      • Adrenergic medications
      • Herbal remedies 
      • Sympathomimetics
      • OCP
      • Steroids
    • Other
      • Obstructive sleep apnea
      • Pregnancy-induced hypertension
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.