ECG of the Week – 2nd October 2017 – Interpretation

By | 4 oktober 2017

The following ECG is from a 16 yr old male who presented with episodes of feeling unwell, nauseous and dizzy. He is on no medication and was investigated for palpitations 7 yrs ago without cause identified.

Click to enlarge

Rate:

  • Initial ventricular rate ~150-160 bpm
  • Period of ventricular bradycardia
  • Subsequent increase in ventricular rate
  • Atrial rate variable ~100-110 bpm

Rhythm:

  • Initial 7 complexes
    • Mix of sinus and accelerated junctional rhythm
  • Next 2 ventricular complexes
    • 2:1 AV block
  • Period of complete AV block / high grade AV block
  • Next 2 ventricular complexes
    • SInus rhythm
  • Followed by accelerated junctional rhythm

Axis:

  • Right axis deviation

Intervals:

  • PR – Normal
    • During periods of sinus conduction
  • QRS – Normal

Additional:

  • Dominant R waves leads V1-2
  • Meets voltage criteria for biventricular hypertrophy
  • Nil features of strain or Q waves

Interpretation:

  • Tachy-brady syndrome
    • Accelerated junctional tachycardia
    • High grade AV block
    • Patient was symptomatic during these episodes of bradycardia complaining of dizziness and nausea. During episodes of tachycardia he experienced palpitations.

What happened ?

He had no reversible cause including culprit medications and normal biochemical assessment. He was transferred for tertiary managment and following further investigation including EP study underwent a PPM insertion.

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.

Geef een reactie

Deze website gebruikt Akismet om spam te verminderen. Bekijk hoe jouw reactie gegevens worden verwerkt.

ECG of the Week – 2nd October 2017 – Interpretation

By | 4 oktober 2017

The following ECG is from a 16 yr old male who presented with episodes of feeling unwell, nauseous and dizzy. He is on no medication and was investigated for palpitations 7 yrs ago without cause identified.

Click to enlarge

Rate:

  • Initial ventricular rate ~150-160 bpm
  • Period of ventricular bradycardia
  • Subsequent increase in ventricular rate
  • Atrial rate variable ~100-110 bpm

Rhythm:

  • Initial 7 complexes
    • Mix of sinus and accelerated junctional rhythm
  • Next 2 ventricular complexes
    • 2:1 AV block
  • Period of complete AV block / high grade AV block
  • Next 2 ventricular complexes
    • SInus rhythm
  • Followed by accelerated junctional rhythm

Axis:

  • Right axis deviation

Intervals:

  • PR – Normal
    • During periods of sinus conduction
  • QRS – Normal

Additional:

  • Dominant R waves leads V1-2
  • Meets voltage criteria for biventricular hypertrophy
  • Nil features of strain or Q waves

Interpretation:

  • Tachy-brady syndrome
    • Accelerated junctional tachycardia
    • High grade AV block
    • Patient was symptomatic during these episodes of bradycardia complaining of dizziness and nausea. During episodes of tachycardia he experienced palpitations.

What happened ?

He had no reversible cause including culprit medications and normal biochemical assessment. He was transferred for tertiary managment and following further investigation including EP study underwent a PPM insertion.

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.

Geef een reactie

Deze website gebruikt Akismet om spam te verminderen. Bekijk hoe jouw reactie gegevens worden verwerkt.