ECG of the Week - 4th July 2016 - Interpretation

The following ECG is from a 75 yr old patient who presented with a rash and fever. They had recently been commenced on lenalidomide for multiple myeloma. They are also on warfarin for a prior mitral valve replacement.



Click to enlarge

 
Rate:

• 48 bpm mean ventricular rate

Rhythm:

• Irregular
• Nil p waves visible 

Axis:

• Right axis deviation

Intervals:

• QRS - Normal (100ms)
• QT - 480ms

Segments:

• ST Depression leads II, III, aVF, V2, V3

 Additional:

• Biphasic T wave inversion leads II, III, aVF
• T wave inversion leads V2/3
• Prominent R waves in all precordial leads
• R/S >/=1 leads V1-3,V5-6

Interpretation:

• Broad differentials:
• Ischaemia
• Drug toxicity esp digoxin
• RVH

 

What happened ?
 

 The patient was transferred to CCU for ongoing investigation and management.The patient remained in 'slow' AF with limited exercise rate response and a single chamber PPM was inserted. The rash was felt to be secondary to chemotherapy and resolved with cessation of lenalidomide. 

Chemotherapy related cardiotoxicity

The following are two nice review articles looking at the various manifestations of cardiotoxicity as they related to chemotherapeutic drug use.

• Bovelli D,Plataniotis G, Roila F, on behalf of the ESMO Guidelines Working Group. Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines. Ann Oncol. 2010; 21(suppl 5):v277-v282. Full text available.
• Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica (Buchar). 2013 Mar; 8(1): 59–67. Full text available.

References / Further Reading

 

Life in the Fast Lane

• RVH
• Atrial Fibrillation

Textbook

 

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