ECG of the Week - 29th February 2016 - Interpretation

The following ECG is from an 80 year old female who presented to the Emergency Department complaining of lethargy and feeling generally unwell.

Click to enlarge

Rate:

• Mean ventricular rate 102 bpm

Rhythm:

• Irregular
• No P waves visible
• Single PVC (Complex #5)

Axis:

• Normal

Intervals:

• QRS - Normal (80ms)
• QT - 400ms (QTc Bazette 380-400 ms)

Segments:

• ST Elevation leads aVR and V1
• ST Depression leads I, II, III, aVF, V4-6

Additional:

Interpretation:

• Atrial Fibrillation with tachycardia
• Things to establish
• Is this new or chronic ?
• Is it primary or secondary ?
• What treatment is the patient on ?
• ST Segment changes
• Broad differentials including:
• ACS
• Electrolyte abnormality
• Drug effect - digoxin

Many people will say this ECG is consistent with LMCA occlusion but we must remember the pattern of STE in aVR and diffuse ST depression is most often seen in demand ischaemia.

In this patient's case she had established AF treated with digoxin. Serial troponins showed a slight rise secondary to her occult GI bleed !

References / Further Reading

Life in the Fast Lane

• ST Elevation in lead aVR

Textbook

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