ECG of the Week – 23rd December 2013 – Interpretation

By | 25 december 2013

The following ECG is from a 58yr old male who was brought to the Emergency Department following an out-of-hospital cardiac arrest. 
The initial rhythm on paramedic arrival was VF, initial DC cardioversion resulted in PEA with ROSC following iv adrenaline. A further episode of pre-hospital VF responded to DC cardioversion.
On arrival to the Emergency Department the patient is intubated, starting to make voluntary movements, with eye opening to stimuli. Vital signs: BP 98/67, BSL 8.2, Temp 36.8
Check out the comments on this case here.
The initial ECG is below:


Click to enlarge

Rate:

  • Atrial rate ~72 bpm
  • Ventricular rate 30 bpm

Rhythm:

  • Complete heart block
  • Ventricular escape rhythm

Axis:

  • Normal

Intervals:

  • QRS – Prolonged (140ms)
  • QT – 660ms

Segments:

  • ST Elevation leads V2-3
  • Nil ST depression

Additional:

  • Right bundle branch block
  • Deep T Inversion leads II, III, aVF, V1-6 
    • Terminal positive deflection leads V2-6

Interpretation:

  • Post arrest ECG
  • Complete heart block
  • Marked T-wave inversion with differentials including:
  • Cardiomyopathy
  • Acid/base or electrolyte disturbance
  • ? Related to DC cardioversion this can cause voltage and ST segment changes but I don’t know if it causes T-wave changes

What happened ?

The patient was kept intubated and sedated. Transcutaneous pacing was commenced and iv adrenaline infusion commenced to maintain BP / MAP. Cardiology services were urgently contacted and transvenous pacing was commenced and the patient transferred for angiography and CT head.
We will continue this case next week with another ECG and the clinical conclusion of the case.

References / Further Reading

Life in the Fast Lane

  • Complete heart block here
  • Ventricular escape rhythm here

Emergency ECG Video of the Week – Amal Mattu

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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