ECG of the Week - 4th January 2016 - Interpretation

This week's ECG is from an 80 yr old female who presented with right upper quadrant pain and fever.



Click to enlarge

Rate:

• 108 bpm

Rhythm:

• Irregular

Axis:

• RAD

Intervals:

• QRS - Prolonged (120-140 ms)

Segments:

• ST Elevation leads I, aVL, V1-4
• ST Depression leads II, III, aVF, V5-6
• Appropriately discordant to QRS vector
• Sgarbossa negative

Additional:

• Fibrillation waves noted in lead V2

Interpretation:

• Atrial fibrillation
• LBBB

Considerations in an elderly febrile patient are:

• Is the AF long-standing or secondary to concurrent illness ?
• What medication is the patient already on ?
• Especially anti-arrhythmic agents and anti-coagulation

What happened ?

The patient had longstanding atrial fibrillation / flutter and was on long term anti-coagulation and beta-blocker therapy. Prior echo showed severe systolic dysfunction, ejection fraction 38%, due to prior ischaemic insult in the LAD territory with severe mitral regurgitation. The  left atrial was also severely dilated.

The fever and abdominal pain were due to acute cholecystitis and the patient was admitted to the hospital with both cardiology and surgical input for management of her condition.

References / Further Reading

Life in the Fast Lane

• Atrial fibrillation

Textbook

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