A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
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Friday, 5 October 2012
ECG of the Week - 8th October 2012
This ECG is from a 62 year old. Presents with cough, fever, and recent diagnosis of pneumonia. An ECG taken 2 weeks previous has been documented as normal, unfortunately the original ECG is not available for comparison.
This ECG is interesting for both it's arrhythmic and non-arrhythmic properties.
Accelerated junctional rhythm (rate about 83/min) dissociated from a slightly slower sinus rhythm (rate about 80/min). Critical lengthening of the R-P interval (i.e., 0.21s) results in ventricular capture of the 5th beat as evidenced by shortening of the RR interval. The 6th beat also ends a ventricular cycle that is shorter than the junctional cycle. This too may represent a second capture beat since the P-R is reasonable and at a conductible length. The remaining 7th through 12th beats are all junctional. This would qualify as A-V dissociation by usurpation.
This ECG also appears to show classic Wellens' syndrome (i.e., "Wellens' warning") suggestive of a tight, critical lesion in the proximal LAD artery. Terminal T-wave inversion in the mid-precordial leads (esp. V2 & V3) without significant ST elevation. Only an urgent cardiac cath would confirm this conclusively.
This ECG is interesting for both it's arrhythmic and non-arrhythmic properties.
ReplyDeleteAccelerated junctional rhythm (rate about 83/min) dissociated from a slightly slower sinus rhythm (rate about 80/min). Critical lengthening of the R-P interval (i.e., 0.21s) results in ventricular capture of the 5th beat as evidenced by shortening of the RR interval. The 6th beat also ends a ventricular cycle that is shorter than the junctional cycle. This too may represent a second capture beat since the P-R is reasonable and at a conductible length. The remaining 7th through 12th beats are all junctional. This would qualify as A-V dissociation by usurpation.
This ECG also appears to show classic Wellens' syndrome (i.e., "Wellens' warning") suggestive of a tight, critical lesion in the proximal LAD artery. Terminal T-wave inversion in the mid-precordial leads (esp. V2 & V3) without significant ST elevation. Only an urgent cardiac cath would confirm this conclusively.
I agree with Jason's rhythm interpretation, but without a suggestive history Wellens' is not on the table for me.
ReplyDeleteI'm thinking of something along the lines of pericarditis or myocarditis.
Another differential for biphasic T-waves like that is cardiomyopathy. However, that seems less likely given a "normal" ECG 2 weeks prior.
ReplyDeleteI would add that with the T-wave inversions extending all the way out to V6, Benign T-wave Inversion (BTI) should be on the DDX list.
ReplyDeleteOf course, as Christopher said, tough to tell without the old ECG.
ReplyDelete