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.

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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

• Digoxin Toxicity

Textbook

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