Wednesday, 7 February 2018

ECG of the Week - 5th February 2018 - Interpretation

The following ECG is from a 35 yr old male who presented with 1 hour of central severe chest pain. He has a past medical history of Type 2 Diabetes and a positive family history. He had recently been unwell with a febrile illness.


Click to enlarge


Rate:

  • 120 bpm
Rhythm:
  • Regular 
  • Sinus rhythm 
Axis:
  • Normal / Inferior
Intervals:
  • PR - Normal (~170ms)
  • QRS - Normal (80ms)
  • QT - 270ms (QTc Bazette 380 ms)
Additional:
  • ST Elevation leads I (<1mm font="">, II (1mm)
  • Baseline artifact limits in precordial leads
  • ST Elevation leads V1-3 (<=1mm)
  • T waves in right precordial leads look prominent
  • Relative high voltages in right precordial leads
  • Absence of ST depression
Interpretation:
  • Sinus tachycardia
  • ST segment changes without reciprocal changes
DDx
  • Benign Early Repolarisation
  • Pericarditis
  • ACS - should always be considered when making a diagnosis of pericarditis
The patient underwent a bedside echo which was normal without evidence of pericardial effusion or regional wall motion abnormality.
He was subsequently treated as pericarditis with symptomatic improvement.
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.