Wednesday, 19 September 2018

ECG of the Week - 17th September 2018 - Interpretation

The following ECG is from a 72 year old female who presented to the Emergency Department complaining of dizziness. She has a history of ischaemic cardiac disease, atrial fibrillation and diabetes.




Click to enlarge

Rate:
  • 36 bpm
Rhythm:
  • Regular ventricular rhythm
  • Atrial fibrillation best appreciated in leads V1-2
    • Irregular atrial activity
    • Absence of P waves
Axis:
  • Normal
Intervals:
  • QRS - Normal 
Additional:
  • T wave inversion leads II, III, aVF, V1-4

Interpretation:

  • 'Regularised' Atrial fibrillation
  • AF + Complete heart block
    • AF - baseline irregularity, no P waves, history of same
    • Complete heart block - regular junctional escape rhythm

What happened ?

The patient was not taking digoxin, a common cause of regularised AF, and failed to respond to isoprenaline. She was taken for urgent PPM insertion and following made an uneventful recovery.

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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