Wednesday, 8 August 2012

ECG of the Week - 6th August 2012 - Interpretation

This ECG is from a 75 year old female.





Click to enlarge

Rate:
  • 84
Rhythm:
  • Irregular
  • No p waves visible

 Axis:
  • Normal (90 deg)
Intervals:
  • Nil p visible
  • QRS - Normal (80ms)
  • QT - 360ms (QTc Bazette ~ 440 ms)

Additional:
  • T Inversion V3-6, II, III, aVF
  • PVC
  • QRS Conduction Abnormality


Interpretation:

  • Atrial Fibrillation
  • Widespread T Wave Inversion



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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3 comments:

  1. Jason E. Roediger, CCT,CRAT9 August 2012 at 06:43

    If I'm not mistaken, this patient also has a ventricular demand pacemaker that is probably programmed in a VVI mode and set to pace at a rate of 60/min. Both the 1st and 14th beats are probably paced fusion beats. There appears to be a pacer stimulus/spike occurring in the first half of the QRS complex and the QRS on the first beat is slightly altered in morphology. The cycle length between the 13th and 14th beats is equivalent to a rate of exactly 60/min. The 10th beat is undoubtedly a ventricular extrasystole and not aberrancy due to Ashman's phenomenon. It also appears that precordial leads V2 and V3 have been reversed/switched. The progression of the QRS and ST-T looks unnatural on both the intrinsic/conducted beats and the ventricular extrasystole in leads V1-3.

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  2. Unknown9 August 2012 at 11:06

    Hi Jason,
    Firstly thank you for your continuing interest and contribution to the blog.
    I had dismissed the spikes in those complexes as I thought the QRS morphology looked similar across all the QRS complex. However, we went back to try and get a bit more information on the patient and managed to find the chest x-ray report which reads “Single lead cardiac pacemaker and aortic valve replacement is in situ. Heart size is enlarged but no evidence of cardiac failure. Lungs demonstrate mild emphysematous changes. No pulmonary infiltrates nor pleural effusion.”
    Fantastic pick on the ECG, you’ve certainly taught us something.
    Again thank you for the contribution and correction.
    John

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  3. Simon23 August 2012 at 18:42

    Thanks for the information - I can pass this onto medical professionals who I know will find it useful

    ReplyDelete

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