ECG of the Week – 24th March 2014 – Interpretation

By | 26 maart 2014

Another old case from my collection. I don’t have any clinical information on the patient or clinical presentation.
Check out the comments on our original post here.



Click to enlarge

Rate:

  • 36

Rhythm:

  • Complexes 1-5
    • Regular
    • R-R Interval ~1500ms 
    • Followed by pause
  • Complex 6
    • Occurs ~2600ms following complex 5
      • Less than 2x preceding R-R interval
  • No p waves visible

Axis:

  • RAD

Intervals:

  • PR – Nil visible p waves
  • QRS – Prolonged (120-140ms)
  • QT – 400ms

Segments:

  • ST Elevation leads II, III, aVF
  • ST Depression leads aVL, V1-5

Additional:

  • T inversion leads II, III, aVF
  • Artifact along baseline
  • Wandering of baseline prior to 3rd complex and after 6th complex
  • ? Pacing spike following 2nd complex likely artifact as nil further evidence of PPM activity


Interpretation:

Differentials for these ECG features may pending on the clinical scenario and patient factors but broadly include:

  • Acute inferior +/- posterior MI
  • Hyperkalaemia – broad, irregular complexes
  • Drug toxicity – sodium channel blockade, digoxin
  • Environmental – hypothermia
  • CNS lesion – bleed, SOL, raised ICP

References / Further Reading

Life in the Fast Lane

  • Inferior STEMI here
  • Hyperkalaemia here

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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