ECG of the Week - 31st December - Interpretation

A bit of a departure from the normal to herald in the New Year.

 

This week we have a rhythm strip I found.

 

I don't have any information on the case, patient, or management.

 

So what you see is what you get !

 

 

 

 

 

Click to enlarge

Two lead rhythm strip, leads II & V2, assuming standard calibration.

 
Three distinct rhythms:
 
Rhythm 1

• Ventricular Rate ~150-100 bpm
• Regular Atrial activity ~300 bpm (Flutter waves)
• Variable conduction block - 2:1 & 3:1
• Intervals
• No P waves
• QRS - Normal (~ 100ms)
• Segments
• ST Depression lead II
• ST Elevation V2
• Additional
• Abrupt termination without preceding slowing of rate, or increasing block

Rhythm 2

• Asystole
• Duration ~4.9 seconds

Rhythm 3

• Sinus rhythm
• Irregular due to rate change
• ~70 bpm to ~80 bpm
• Intervals:
• PR - Normal (~160ms)
• QRS - Normal (100ms)
• QT - 400ms (QTc Bazette ~ 460 ms)
• Segments:
• ST Depression 1mm lead II
• ST Elevation 3-4mm lead V2
• Additional
• P wave inversion V2

 
Interpretation:

• Atrial flutter with variable block
• Period of aystolic pause
• Followed by sinus rhythm at appropriate rate
• ST Segment changes - ? ischaemic ? hypertrophy

I don't have any clinical information on this case, differentials for these finding could include:

• Iatrogenic
• Chemical cardioversion
• Correction of underlying acid/base or electrolyte disturbance
• Sinus Node Dysfunction

Waitng to hear some of the thoughts of the 'ECG of the Week' team on this one, I will update this post once all the team has had chance to have a look.
 
References / Further Reading 

 

Textbook

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