ECG of the Week - 1st October 2012 - Interpretation

This ECG is from a 22 year old female with sudden onset severe headache.

Click to enlarge

Rate:

• 54

Rhythm:

• Regular
• Sinus Rhythm

Axis:

• Normal (-14 deg)

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (80ms)
• QT - 440-480ms (QTc Bazette ~ 420 ms)

Additional:

• Deep T wave inversion V2-6, I, II, III, aVF
• Positive T wave aVR
• Positive deflection terminal portion T waves - ? TU fusion best seen precordial leads

Interpretation:

In clinical setting of severe headache and widespread T wave changes this is concerning for raised ICP, in this case ? subarachnoid haemorrhage ? intra-cranial bleed
The patient had a normal CT scan and was transferred to a tertiary center for further investigation and management of other co-morbidities.

References / Further Reading

Life in the Fast Lane

• ECG changes in Raised ICP here

Textbook

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