Wednesday 27 February 2019

ECG of the Week - 25th February 2019 - Interpretation

The following ECG is from a 75 yr old male who presented hypotensive and febrile with suspected intra-abdominal sepsis.


Rate:
  • 78 bpm
Rhythm:
 
  • Complexes #1-3 & #7-12
    • Sinus rhythm
  • Complexes #4-6
    • PVC
    • Different morphology than sinus complexes
    • QRS widening

Axis:
  • Normal 
Intervals - sinus complexes:
  • PR - Normal
  • QRS - Normal
Additional:
  • Start of ECG missing
  • ST Depression V1-2
  • ST Elevation leads II, III, V4-6
    • Not typically seen morphology
  • Baseline wander ? contributing to ST abnormality
  • Discordant ST changes in PVCs
ST Morphology
 
Unfortunately I don't have more information of this case in terms of clinical closure.
The ST morphology is unusual and certainly not commonly seen there are a few potential differentiations for this morphology emerging in the literature:
  • Could it be due to artefact - the morphology o the STE does seem to vary beat to beat
  • Give the morphology a name - there a several examples and case reports of similar morphologies associated with differing clinical scenarios
    • 'Shark Fin' STE - Dr Smith's ECG Blog Case - Associated with acute coronary artery occlusion.
    • 'Lambda wave' may be a predictor of VF risk in AMI - Article 1 , Article 2
    • 'Lambda wave' also be associated with takotsubo cardiomyopathy and may confer a worse prognosis - Article 3
  
References / Further Reading
 
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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