ECG of the Week - 15th January 2018 - Interpretation

The following ECG is from a 63 yr old female who presented with a 3 day history of colicky right upper quadrant abdominal pain. She is normally fit and well and has no prior past medical history.

Click to enlarge

Rate:

• 78 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (80ms)

Additional:

• ST Elevation leads V2-5 (~1mm)
• Subtle ST elevation leads II, III, aVF, V6
• T wave inversion leads II, III, aVF, V3-6
• Absence of ST depression
• Low voltage P wave with notching in lead II

Interpretation:

• Diffuse ST and T wave changes

DDx includes:

• ACS
• Demand ischaemia secondary to sepsis
• Cardiomyopathy - acute vs chronic
• Electrolyte abnormality / Acid-base disturbance

This patient had no history of chest pain, nil pre-existing medical condition and was not significantly unwell from her assumed cholecystitis. Vital signs and electrolytes were normal.
She was admitted under the cardiology team for further investigation of ECG abnormalities with surgical consultation for management of cholecystitis.
The patient had raised cardiac biomarkers and underwent angiography.
The angiogram showed no coronary vessel disease but Takotsubo pattern cardiomyopathy, EF 35-40%. The patient was commenced on beta-blocker, ACE and diuretic therapy and will undergo an elective cholecystectomy once normal cardiac function returns on follow-up echo.

Check out some great cases from Dr Smith's ECG blog on Takotsubo here:

• COPD Exacerbation precipitating Takotsubo - great echo images
• Infarction mimicking Takotsubo !!!

Other resources

• eMedicine - Takotsubo Cardiomyopathy
• Life in the Fast Lane - Tako-tsubo Cardiomyopathy

References / Further Reading

Life in the Fast Lane

• Takotsubo Cardiomyopathy

Textbook

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