Wednesday 13 February 2019

ECG of the Week - 11th February 2019 - Interpretation

The following ECG is from a 70 year old female who was referred by her GP following an episode of chest pain.



Click to enlarge

Rate:
 
  • 72 bpm
Rhythm:
 
  • Regular
  • Sinus rhythm 
Axis:
  • Normal (-30 deg)
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (100ms)
Additional:
  • Flat lead II - near isoelectric
  • Complete reversal leads III, aVF
    • T inversion
    • Negative QRS
    • Negative P waves - low voltage
  • Prominent T wave lead V2
  • ST depression leads V5-6

Interpretation:
  • Multiple abnormalities in limb leads
    • Secondary to complex lead reversal - not typical of paired lead swap
  • Prominent T wave in lead V2 with ST depression in lateral leads 
What happened ? A repeat ECG with correct lead position resulted in resolution of all limb lead abnormalities and unchanged non-dynamic precordial lead changes.Serial cardiac biomarkers were negative and the patient was discharge.
 
References / Further Reading
 
Life in the Fast Lane
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

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