ECG of the Week - 1st October 2018 - Interpretation

The following ECG is from a 81 yr old male who presented feeling generally unwell and nauseous. He has a history of chronic AF, T2DM and hypertension.

 

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Rate:

• 42 bpm (mean ventricular rate)

Rhythm:

• Irregular 
• No P waves 

Axis:

• Normal

Intervals:

• QRS - Prolonged

Additional:

• RBBB Morphology
• ST Depression & T wave inversion leads V213
• Slight STE leads aVR & aVL

Interpretation:

•  Slow atrial fibrillation

Differentials for slow atrial fibrillation include:

• Drugs - digoxin, CCB, Beta-blockers, other anti-arrhythmics
• Sinus node dysfunction
• ACS
• Electrolyte abnormality
• Environmental - hypothermia
• Endocrine - hypo- / hyper-thyroid
• Infiltrative
• High vagal tone states

  
References / Further Reading

 

Life in the Fast Lane

• Atrial fibrillation

Textbook

 

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