ECG of the Week - 14th May 2018 - Interpretation

This ECG is from a 68 yr male who presented with 24 hours of dysponea and palpitations.
No past medical history of note and he takes no regular medications.

Click to enlarge

Things to think about

• What are the key ECG features ?
• What are the potential reversible causes for these features ?
• How would you manage this patient ?

Rate:

• Ventricular rate 42 bpm
• Atrial rate 84 bpm

Rhythm:

• Regular atrial and ventricular activity
• 2:1 AV block

Axis:

• Normal

Intervals:

• PR - Normal (~200ms)
• QRS - Prolonged (140ms)

Additional:

• RBBB Morphology
• Prominent T wave lead III in relation to QRS height

Interpretation:

• 2:1 AV Block

What happened ?

The patient was admitted under the cardiology team and telemetry revealed intermittent variable AV block (2nd and 3rd degree) and he underwent an uneventful dual chamber PPM insertion.

References / Further Reading

Life in the Fast Lane

• 2:1 AV Block

Textbook

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