Wednesday, 21 March 2018

ECG of the Week - 19th March 2018 - Interpretation

The following ECG is from an 85 yr old male who presented with dizziness and an abnormal gait.

 
Click to enlarge
Rate:
  • Mean ventricular rate 60 bpm
Rhythm:
  • Irregular ventricular complexes
  • Flutter / fib waves best seen in leads aVF & V1
Axis:
  • LAD
Intervals:
  • QRS - Normal (80ms)
Additional:
  • Early R wave transition between V1 & V2
  • Subtle ST depression leads V4-6
  • Flat T wave lead aVL
Interpretation:
  • Atrial fibrillation
    • Rate controlled
Considerations in atrial fibrillation There are a number of things to think about when encountering a patient with atrial fibrillation.
  • Onset
    • Acute vs chronic
    • Duration
  • Rate disturbance
    • Rapid ventricular response
    • Normal rate
    • Bradycardia - may be secondary to therapy or tachy/brady syndrome
  • Complication of AF
    • Cardiac failure
    • Hypotension
    • Ischaemia
    • Thromboembolic / CVA
  • Current therapy
    • Anti-coagulation
    • Anti-arrhythmics
    • Complications of therapy
  • Drug toxicity
    • Bleeding
    • Precipitant / Causative factors
    • Infection / Ischaemia / Structural / Endocrine / Metabolic
Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including: AF Related Calculators (links to MDCalc)
What happened ? This patient had known chronic atrial fibrillation and acute presentation was secondary to an acute embolic CVA.
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.