Wednesday, 4 July 2018

ECG of the Week - 2nd July 2018 - Interpretation

The following ECG is from a 57yr old female who presented with chest pain on a background of known mitral stenosis secondary to rheumatic fever.
 
Click to enlarge


Rate:
  • Ventricular rate 130 bpm
  • Atrial rate ~260 bpm
Rhythm:
  • Regular ventricular rhythm
  • Regular atrial activity 
    • Best seen lead V2
    • Abnormal p wave morphology
Axis:
  • RAD
Intervals:
  • QRS - Normal (80ms)
Additional:
  • Voltage criteria for LVH
    • Deep S wave leads V2-3
    • Subtle ST depression and T wave inversion lead V6
Interpretation:
  • Atrial flutter with 2:1 block
What happened ?

The patient was admitted under the cardiology team for investigation and management. Telemetry revealed intermittent rhythm alteration between atrial flutter and fibrillation.
A transoesophageal echo showed:
  • Mildly reduced LV function
  • Severely dilated left atrium
  • Thrombus in left atrial appendage
  • Moderate rheumatic mitral stenosis
Treatment with beta-blocker therapy, anti-coagulation and ACE inhibitor was initiated.

Rheumatic Fever and Rheumatic Heart Disease

The following link contains the Australian recommended diagnostic criteria, clinical management, e-learning resources and patient information:


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.