Wednesday, 15 August 2018

ECG of the Week - 13th August 2018 - Interpretation

The following ECG is from a 72 yr old male who presented with chest pain and palpitations. He has a history of hypertension and hypercholesterolaemia.



Click to enlarge

Rate:
  • 220 bpm
Rhythm:
  • Regular
Axis:
  • LAD
Intervals:
  • QRS - Prolonged (210ms)
Additional:
  • Typical LBBB Morphology
  • Apparent atrial activity within QRS in leads V5-6
  • Absent fusion or capture beats

Interpretation:
  • Wide Complex Tachycardia
  • DDx
    • VT
    • SVT with aberrancy
    • SVT with pre-existing BBB
    • SVT with pre-excitation

Differentiating SVT from VT can be difficult and not always possible, also it may not be clinically necessary.
VT would be favoured given the patients age and co-morbidites whereas the the typical LBBB morphology and visible regular atrial activity favors SVT.
You can check out more on differentiating VT from SVT in a number of other blogs and posts, selection below:

What happened ?

The patient underwent urgent DC cardioversion and was taken for angiogram which showed a mid LAD stenosis which was stented.

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.

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