ECG of the Week - 28th January 2013 - Interpretation

This week's ECG was kindly donated by @UnaNicI. It's from a 45 year old male.

 

 

 

 

Click to enlarge
 

Rate:

• ~66 bpm

Rhythm:

• Sinus
• Sinus Arrhythmia - minor

Axis:

• Normal (+30 deg)

Intervals:

• PR - Normal (~120ms)
• QRS - Normal (80-100ms)
• QT - 400ms (QTc Bazette ~ 410 ms)

Segments:

• Up sloping ST elevation V2
• No ST depression

Additional:

• T wave inversion V1- V6, I, aVL
• T Inversion V2 - V4 exceptionally deep
• Biphasic T wave V2 - V6
• Variable QRS amplitude in 1st, 4th, and 8th complexes without significant baseline disturbance

Differentials:

• LAD Lesions- Wellen's
• Myocarditis
• Takotsubo's Cardiomyopathy
• Sympathomimetic use / toxicity
• CNS Lesion - 'Cerebral' T waves
•  Hypertrophic Cardiomyopathy

Dr Razak has recommended a nice review paper on ST-segment depression and T wave inversion, by EB Hanna and DL Glancy, for those of you who want to read further on this topic, the full text can be found here.

References / Further Reading

 

Life in the Fast Lane

• Hypertrophic cardiomyopathy here
• Myocarditis here
• Wellen's here
• Takotsubo's cardiomyopathy here

Article

• Hanna EB, Glancy DL. ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med. 2011 Jun;78(6):404-14. PMID: 21632912 Full text here

 Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005. 21632912