Wednesday, 16 May 2018

ECG of the Week - 14th May 2018 - Interpretation

This ECG is from a 68 yr male who presented with 24 hours of dysponea and palpitations.
No past medical history of note and he takes no regular medications.

Click to enlarge
Things to think about
  • What are the key ECG features ?
  • What are the potential reversible causes for these features ?
  • How would you manage this patient ?
Rate:
  • Ventricular rate 42 bpm
  • Atrial rate 84 bpm
Rhythm:
  • Regular atrial and ventricular activity
  • 2:1 AV block
Axis:
  • Normal
Intervals:
  • PR - Normal (~200ms)
  • QRS - Prolonged (140ms)
Additional:
  • RBBB Morphology
  • Prominent T wave lead III in relation to QRS height
Interpretation:
  • 2:1 AV Block
What happened ?

The patient was admitted under the cardiology team and telemetry revealed intermittent variable AV block (2nd and 3rd degree) and he underwent an uneventful dual chamber PPM insertion.

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.