ECG of the Week – 15th May 2017 – Interpretation

The following ECG is from an 81yr old female who presented with a 48hr history of palpitations. She underwent a cardioversion for an atrial arrhythmia 1 year ago. Her medications include metoprolol, digoxin and eliquis.





Click to enlarge

Rate:

  • 132 bpm

Rhythm:

  • Regular
  • Possible atrial activity seen in leads I, II, III and aVF
  • Lead II suggests inverted small atrial waves seen with ST segment and T-QRS interval

Axis:

  • Normal

Intervals:

  • QRS – Normal 

Additional:

  • ST Elevation lead aVR
  • ST Depression leads II, III, aVF, V4-6
    • Likely to reflect rate related demand changes and superimposed atrial activity

Interpretation:

  • Regular narrow complex tachycardia
  • Differentials:
    • Atrial flutter with 2:1 block – favoured due to the patient’s history of AF
    • Atrial tachycardia with 2:1 block


What happened ?

Following screening for acute electrolyte disturbance, non-cardiac precipitant, drug toxicity and ensuring compliance with coagulation regime the patient underwent an uneventful DC cardioversion under procedural sedation.

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 – 15th May 2017

The following ECG is from an 81yr old female who presented with a 48hr history of palpitations. She underwent a cardioversion for an atrial arrhythmia 1 year ago. Her medications include metoprolol, digoxin and eliquis.





Click to enlarge



Things to think about

  • What are the key ECG features ?
  • What consideration would influence your management of this patient ?

ECG of the Week – 8th May 2017 – Interpretation

The following ECG is from a 12 yr old who presented to the Emergency Department following an episode of dysponea and palpitations.

 
Click to enlarge

Rate:

 
  • 72 bpm

Rhythm:

 

  • Sinus rhythm
    • Note baseline irregularity due to printing issue

Axis:

  • Normal

Intervals:

 

Complexes #1-9, #12

  • PR – Normal
  • QRS – Normal

Complexes #10-11

  • PR – Short
  • QRS – Prolonged


Additional:

  • Distinct QRS morphology complexes #10-11
    • Delta wave
    • Abnormal ST / T wave likely secondary to pre-excitation


Interpretation:
  • Intermittent pre-excitation / WPW
    • Only seen in complexes #10-11

What happened ?
 

The patient was referred to paediatric cardiologists for further follow-up and investigation.

 

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.