ECG of the Week - 9th July 2018 - Interpretation

This ECG is from a 81yr old female who presented with lethargy and weakness. She has a history of schistosomiasis with resultant liver disease, portal hypertension and ascites.

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Rate:

• 66 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• RAD / Extreme (-180 deg)

Intervals:

• PR - Normal (~200ms)
• QRS - Normal (80ms)

Additional:

• Broad notched P wave leads II, III, aVF
• Left atrial abnormality
• Lead I completely inverted - Negative P/QRS/T
• Lead aVR QRS positive with lead V1 QRS negative
• Global T wave flattening
• Baseline artefact

Interpretation:

• Left arm / Right arm lead reversal
• Resultant changes on this ECG
• Negative lead I
• Switch aVR and aVL
• Switch II and III

Schistosomiasis

Schistosomiasis ( bilharziasis or snail fever) is caused by parasitic worm infection acquired through exposure with contaminated water. The Schistosoma parasite can infected the host via unbroken skin or ingestion. 
Early infection can be asymptomatic, cause urticarial dermatitis or pruritic dermatitis. Katayama syndrome can develop 4-8 weeks post-infection characterized by fever, headache, cough, urticaria , diarrhoea, hepatosplenomegaly and hypereosinophilia. 
Long-term infection can cause bladder scarring, calcification, squamous cell carcinoma of the bladder, seizure, paralysis, transverse myelitis, periportal fibrosis, hepatic granulomas and portal hypertension depending of the species of Schistosoma involved.

References / Further Reading

Life in the Fast Lane

• Lead reversal
• P Wave Morphology

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.