ECG of the Week – 7th August 2017 – Interpretation

By | 9 augustus 2017

The following ECG is from a 59 yr old female who presented to the Emergency Department complaining of palpitations.




Click to enlarge

Rate:

  • Mean ventricular rate 144 bpm

Rhythm:

  • Irregular
  • Nil regular P waves visible
  • Notching terminal QRS complexes #8 and #9 in aVF 
    • ? fibrillation waves ? Retrograde P ? SA activity

Axis:

  • Normal

Intervals:

  • QRS – Normal

Additional:

  • ST Depression leads II, III, aVF, V3-6
  • ST elevation lead aVR
  • T wave inversion leads II, III, aVF

Interpretation:

  • Atrial fibrillation
    • Rapid ventricular response
    • ST / T wave changes likely rate-related demand ischaemia

Clinical Factors in Atrial Fibrillation

There are several features to establish on assessment of the patient in atrial fibrillation that will influence both the immediate and long-term management strategies, including:

  • Onset and duration of symptoms
  • Likelihood of paroxysmal episodes
  • Evidence of compromise from AF
    • Chest pain, cardiac failure, hypotension etc.
  • Current medications
    • Especially anti-coagulation and anti-arrhythmics
  • Potential precipitant / cause
    • E.g. sepsis, electrolyte abnormality, endocrine disease
  • Suitability and contra-indications to management options
    • E.g. fasting status, anaesthetic risk, drug allergy / intolerance, bleeding risk

Management Options in Atrial Fibrillation

There are several considerations in the management of AF which include:

  • Rate vs. rhythm control
    • Electrical vs Chemical rhythm control
  • Anti-coagulation
    • Risk vs Benefit
    • Drug to use
  • ? Underlying precipitant
    • Infection / ischaemia / structural / endocrine / metabolic etc.
  • Follow-up / disposition
  • Ablation suitability

Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including:

AF Related Calculators (links to MDCalc)

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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ECG of the Week – 7th August 2017 – Interpretation

By | 9 augustus 2017

The following ECG is from a 59 yr old female who presented to the Emergency Department complaining of palpitations.




Click to enlarge

Rate:

  • Mean ventricular rate 144 bpm

Rhythm:

  • Irregular
  • Nil regular P waves visible
  • Notching terminal QRS complexes #8 and #9 in aVF 
    • ? fibrillation waves ? Retrograde P ? SA activity

Axis:

  • Normal

Intervals:

  • QRS – Normal

Additional:

  • ST Depression leads II, III, aVF, V3-6
  • ST elevation lead aVR
  • T wave inversion leads II, III, aVF

Interpretation:

  • Atrial fibrillation
    • Rapid ventricular response
    • ST / T wave changes likely rate-related demand ischaemia

Clinical Factors in Atrial Fibrillation

There are several features to establish on assessment of the patient in atrial fibrillation that will influence both the immediate and long-term management strategies, including:

  • Onset and duration of symptoms
  • Likelihood of paroxysmal episodes
  • Evidence of compromise from AF
    • Chest pain, cardiac failure, hypotension etc.
  • Current medications
    • Especially anti-coagulation and anti-arrhythmics
  • Potential precipitant / cause
    • E.g. sepsis, electrolyte abnormality, endocrine disease
  • Suitability and contra-indications to management options
    • E.g. fasting status, anaesthetic risk, drug allergy / intolerance, bleeding risk

Management Options in Atrial Fibrillation

There are several considerations in the management of AF which include:

  • Rate vs. rhythm control
    • Electrical vs Chemical rhythm control
  • Anti-coagulation
    • Risk vs Benefit
    • Drug to use
  • ? Underlying precipitant
    • Infection / ischaemia / structural / endocrine / metabolic etc.
  • Follow-up / disposition
  • Ablation suitability

Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including:

AF Related Calculators (links to MDCalc)

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.