ECG of the Week - 18th May 2015 - Interpretation

This ECG is from a 65yr old male. He presented to the Emergency Department feeling generally unwell for 1 week with subjective fevers and night sweats. He had episodic dysponea and myalgia. He denied any chest pain during this illness. He had a previous episode of paroxysmal atrial fibrillation.
He was afebrile at presentation with a blood pressure of 85mmHg systolic.
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Rate:

• 132 bpm

Rhythm:

• Atrial fibrillation
• Irregular rhythm
• Fibrillatory waves visible in leads V1-2

Axis:

• Normal

Intervals:

• QRS - Normal (80ms)

Segments:

• ST Elevation leads I, II, aVL, aVF, V1-6
• ST Depression lead aVR

Interpretation:

• Atrial Fibrillation with rapid ventricular response
• Diffuse ST segment elevation

DDx

• Pericarditis
• Myocarditis
• ACS

What happened ?

The patient had an urgent echo which showed no significant regional wall motion abnormality or pericardial effusion. 

He was investigated and treated for potential sepsis, malignancy, auto-immune disease and vasculitis. Further investigation revealed an OM1 stenosis but this was not felt to be a culprit lesion.

The final diagnosis was one of pneumonia with SIRS and a myo-pericarditis.


References / Further Reading

Life in the Fast Lane

• Atrial Fibrillation
• Myocarditis
• Pericarditis
• Pericardial Effusion

Textbook

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