Wednesday, 3 October 2018

ECG of the Week - 1st October 2018 - Interpretation

The following ECG is from a 81 yr old male who presented feeling generally unwell and nauseous. He has a history of chronic AF, T2DM and hypertension.

 
Click to enlarge
  
Rate:
  • 42 bpm (mean ventricular rate)
Rhythm:
  • Irregular 
  • No P waves 
Axis:
  • Normal
Intervals:
  • QRS - Prolonged
Additional:
  • RBBB Morphology
  • ST Depression & T wave inversion leads V213
  • Slight STE leads aVR & aVL
Interpretation:
  •  Slow atrial fibrillation
Differentials for slow atrial fibrillation include:
  • Drugs - digoxin, CCB, Beta-blockers, other anti-arrhythmics
  • Sinus node dysfunction
  • ACS
  • Electrolyte abnormality
  • Environmental - hypothermia
  • Endocrine - hypo- / hyper-thyroid
  • Infiltrative
  • High vagal tone states

  
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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