ECG of the Week - 11th June 2018 - Interpretation

This ECG is from a 60 yr old male with known haemochromatosis who presented with a 1 week history of intermittent cardiac sounding chest pain.

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Rate:

• 72 bpm

Rhythm:

• Sinus rhythm
• Sinus arrythmia

Axis:

• Normal

Intervals:

• PR - Normal (~180ms)
• QRS - Normal (80ms)
• QT - 370ms (QTc Bazette 390 ms)

Additional:

• ST Elevation lead II (less than 1mm)<1mm font="">
• P wave notching lead II
• Biphasic P wave lead III

Interpretation:

• Non-diagnostic ECG
• Left atrial abnormality
• Note ECG voltage criteria for atrial abnormalities are poorly sensitive for actual chamber enlargement

Cardiac sequela of haemochromatosis

Cardiac effects of haemochromatosis include initial diastolic dysfunction, risk of arrhythmia and subsequent dilated cardiomyopathy.

What happened ?

The patient was admitted under the cardiology team and subsequent angiogram showed:

• Moderate ostial disease
• Diffuse mid-LAD disease
• Severe distal circumflex disease

Follow-up echo showed:

• Normal biatrial size
• Moderate concentric LV hypertrophy

References / Further Reading

 

Textbook

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