ECG of the Week: ECG of the Week - 29th April 2013

Wednesday 1 May 2013

ECG of the Week - 29th April 2013 - Interpretation

This ECG is from a 47 year old female presenting with palpitations of 3 hours duration.

Click to enlarge

Rate:

156 bpm mean rate

Varies between ~135 - 185 bpm

Rhythm:

Irregularly irregular
Nil p waves

Axis:

Normal (+45 deg)

Intervals:

PR - Nil p waves visible
QRS - Normal (60-80 ms)
QT - 240-280ms (QTc Bazette ~ 360-470 ms)

Segments:

ST Elevation lead aVR (1mm)
ST Depression leads I, II, III, aVF, V4-6

Interpretation:

Atrial Fibrillation with rapid ventricular response

a.k.a 'Fast AF'
Inferolateral ischaemic changes

? Rate related

VAQ Corner

Our VAQ style question for this ECG was :

47 year old female presents complaining of palpitations onset 3 hours age. She denies chest pain and is not short of breath. She has no prior medical history. Blood pressure is 120/75.

Her ECG is above.

a) Describe and interpret her ECG (30%)
b) Outline your management options (70%)

Management Options in Atrial Fibrillation

There are several considerations in the management of AF which include:

Rate vs. rhythm control

Electrical vs Chemical rhythm control

Anti-coagulation

Risk vs Benefit
Drug to use

? Underlying precipitant

Infection / ischaemia / structural / endocrine / metabolic etc.

Follow-up / disposition
Ablation suitability

Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including: