ECG of the Week - 2nd July 2018 - Interpretation

The following ECG is from a 57yr old female who presented with chest pain on a background of known mitral stenosis secondary to rheumatic fever.

 

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Rate:

• Ventricular rate 130 bpm
• Atrial rate ~260 bpm

Rhythm:

• Regular ventricular rhythm
• Regular atrial activity 
• Best seen lead V2
• Abnormal p wave morphology

Axis:

• RAD

Intervals:

• QRS - Normal (80ms)

Additional:

• Voltage criteria for LVH
• Deep S wave leads V2-3
• Subtle ST depression and T wave inversion lead V6

Interpretation:

• Atrial flutter with 2:1 block

What happened ?

The patient was admitted under the cardiology team for investigation and management. Telemetry revealed intermittent rhythm alteration between atrial flutter and fibrillation.
A transoesophageal echo showed:

• Mildly reduced LV function
• Severely dilated left atrium
• Thrombus in left atrial appendage
• Moderate rheumatic mitral stenosis

Treatment with beta-blocker therapy, anti-coagulation and ACE inhibitor was initiated.

Rheumatic Fever and Rheumatic Heart Disease

The following link contains the Australian recommended diagnostic criteria, clinical management, e-learning resources and patient information:

• RHD Australia

References / Further Reading

Life in the Fast Lane

• Atrial flutter
• LVH

Textbook

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