ECG of the Week – 22rd January 2018

The following ECG is from a 78 yr old female who presented to the Emergency Department with a history of progressively worsening dysponea and peripheral oedema. Her past medical history includes ischaemic heart disease and hypertension.


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Things to think about

  • What are the key ECG abnormalities ?
  • How could you improve the quality of the patient's ECG ?

ECG of the Week – 15th January 2018 – Interpretation

The following ECG is from a 63 yr old female who presented with a 3 day history of colicky right upper quadrant abdominal pain. She is normally fit and well and has no prior past medical history.


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Rate:
  • 78 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (80ms)
Additional:
  • ST Elevation leads V2-5 (~1mm)
  • Subtle ST elevation leads II, III, aVF, V6
  • T wave inversion leads II, III, aVF, V3-6
  • Absence of ST depression
  • Low voltage P wave with notching in lead II
Interpretation:
  • Diffuse ST and T wave changes
DDx includes:
  • ACS
  • Demand ischaemia secondary to sepsis
  • Cardiomyopathy - acute vs chronic
  • Electrolyte abnormality / Acid-base disturbance
This patient had no history of chest pain, nil pre-existing medical condition and was not significantly unwell from her assumed cholecystitis. Vital signs and electrolytes were normal.
She was admitted under the cardiology team for further investigation of ECG abnormalities with surgical consultation for management of cholecystitis.
The patient had raised cardiac biomarkers and underwent angiography.
The angiogram showed no coronary vessel disease but Takotsubo pattern cardiomyopathy, EF 35-40%. The patient was commenced on beta-blocker, ACE and diuretic therapy and will undergo an elective cholecystectomy once normal cardiac function returns on follow-up echo.

Check out some great cases from Dr Smith's ECG blog on Takotsubo here:
Other resources
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.