ECG of the Week – 1st September 2014

This ECG is from a 68 yr old male. He was 2  months post pacemaker insertion for sinus node dysfunction and presented following an episode of syncope.



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VAQ Corner

A 68 yr old male presents to your Emergency Department following an episode of syncope.
2 months prior he had a pacemaker inserted for Sinus Node Dysfunction.


  • Describe & interpret his ECG

ECG of the Week – 25th August 2014 – Interpretation

This ECG is from a 45 yr old male presenting to the Emergency Department following an episode of chest pain. He was pain  free when this ECG was recorded.

Check out the comments from our original post here.

Click to enlarge

Rate:
  • 60
Rhythm:
  • Sinus arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Short (100ms)
  • QRS - Prolonged (140ms)
  • QT - 400ms (QTc Bazette 400 ms)
Segments:
  • ST Elevation leads aVR, V1-4
  • ST Depression leads I, II, III, aVF, V5-6
Additional:
  • Voltage criteria for LVH
  • Delta waves best seen infero-laterally
Interpretation:

  • Wolff-Parkinson-White Syndrome
    • ST segment changes proportional and discordant to QRS direction
    • Anteroseptal pathway (Arruda Algorithm)

What happened ?

The patient had known WPW and serial ECG's and biomarkers were negative and he was referred for an out-patient provocation test.

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.

ECG of the Week – 25th August 2014

This ECG is from a 45 yr old male presenting to the Emergency Department following an episode of chest pain. He was pain  free when this ECG was recorded.




Click to enlarge
VAQ Corner

A 45 yr old male presents to your Emergency Department following an episode of chest pain.
He has no significant past medical history. He is pain free during this ECG recording.


  • Describe & interpret his ECG

ECG of the Week – 18th August 2014 – Interpretation

This ECG is from a 25 yr old male presenting with 3 days of sharp central chest pain.

Check out the comments on our original post here.


Click to enlarge
Rate:
  • 110 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (160ms)
  • QRS - Normal (80ms)
  • QT - 300ms (QTc Bazette 410 ms)
Segments:
  • Widespread ST elevation leads I, II, III, aVF, V2-6
    • Concave morphology
  • ST Depression lead aVR
Additional:
  • PR depression leads I, II, III, aVF, V4-6
  • PR elevation lead aVR
  • Down-sloping T-P segment best seen in lead II
Interpretation:
  • Pericarditis 
  • Note sinus tachycardia - ? effusion

What happened ?

The patient was admitted under the cardiology team. Blood tests showed a negative troponin but raised inflammatory markers and D-dimer. A subsequent CTPA showed a pericardial effusion and the patient underwent pericardiocentesis for a large effusion, total drainage of ~900mls of fluid ! 
The ultimate diagnosis was of viral pericarditis complicated by pericardial effusion.

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.

ECG of the Week – 11th August 2014 – Interpretation

This ECG is from an 80 yr old male who presented with a 1 weeks worth of chest pain.
Complex past medical history with significant cognitive impairment. Multiple medications but nil sodium channel blocking agents.
Check out the comments on our original post here.


Click to enlarge

Rate:
  • 78
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~200ms)
  • QRS - Normal (80ms)
  • QT - 340ms (QTc Bazette 390 ms)
Segments:
  • Up-sloping ST elevation V2-4
Additional:

  • Biphasic T wave leads V2-4
  • T wave inversion lead I, aVL
Interpretation:
  • Wellens' pattern T wave / ST changes
What happened ?

The patient had raised ischemic biomarkers, however given the severity of his co-morbidities nil further intervention was performed.
An ECHO showed concentric left ventricular hypertrophy with posterior wall akinesis.

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.