Wednesday, 25 July 2018

ECG of the Week - 23rd July 2018 - Interpretation

The following ECG is from a 71yr old male who presented with several episodes of ischaemic sounding chest pain on a background of known ischaemic cardiac disease.

Click to enlarge

Rate:
  • Mean rate 66 bpm
Rhythm:
  • Sinus rhythm
  • Unifocal PVCs
Axis:
  • Normal
Intervals:
  • PR - Normal (~200ms)
  • QRS - Prolonged (120-130 ms)
  • QT - 410ms (QTc Bazette 470 ms)
Additional:
  • QRS fragmentation 
    • Best seen leads V2-3
    • Lead V2 rsr's'r''s'' pattern
    • Lead V3 rsr's' pattern
  • T wave inversion leads V4-5
  • ST elevation leads aVR and aVL (< 1mm)<1mm font="">
  • ST depression leads II, III, aVF
Interpretation:
  • ST and T wave changes
    • Likely ACS given history 
    • Needs serial ECGs and comparison with prior ECGs
  • QRS Fragmentation
    • Caused by abnormal ventricular repolarisation
    • Due to myocardial scarring, fibrosis or ischaemia
QRS Fragmentation

The two following papers are a great overview of QRS fragmentation including diagnostic morphologies and clinical relevance in terms of associations and effects on morbidity and mortality.
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.