ECG of the Week - 26th September 2016 - Interpretation

The following ECG is from a 61 yr old male who presented confused having been found on the floor. He has a past medical history of gout and Parkinson's. He is unable to give a list of his medications.

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Rate:

• 48 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Prolonged(~210ms)
• QRS - Normal (80-100ms)
• QT - 480ms (QTc Bazette 430 ms)

Segments:

• Nil abnormalities

Additional:

• Osborne / J waves best seen in leads V5-6
• Baseline artifact
• ? Parkinson's tremor
• ? Shivering artifact
• Completely inverted lead III
• Negative P, QRS & T
• Likely LA/LL Reversal
• Results in inverted III, switch of I & II and switch of aVL & aVF
• Low voltage ECG with the exception of V6

Interpretation:

Changes consistent with hypothermia

• Bradycardia
• 1st Degree AV block
• J waves

What happened ?

The patient's core temperature was 31.1 degrees Celsius. 

There are multiple potential causes of hypothermia including:

• Cold water immersion
• Cold / wet / windy environments
• Exhaustion
• Excessive activity e.g. marathon runners
• Head injury
• Trauma inc. entrapment
• Immobility +/- trauma
• Major burns
• Drugs inc. sedatives, alcohol, phenothiazines
• CVA
• Parkinson's disease
• Sepsis
• Endocrine inc. adrenal insufficiency, hypothyroid, hypoglycaemia
• Malnutrition
• Iatrogenic inc. massive transfusion, fluid resuscitation, exposure
• Age - elderly and neonates

References / Further Reading

Life in the Fast Lane

• Hypothermia
• Limb Lead Reversals
• Low voltage ECG

Textbook

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