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.




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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.

ECG of the Week – 4th August 2014 – Interpretation

This week's ECG is from an 80 yr old patient presenting with chest pain.
History of recent PPM insertion for tachy/brady syndrome.
Check out the comments on our original post here.





Click to enlarge
Rate:
  • 66 bpm
    • Mean ventricular response
Rhythm:
  • Irregular
  • Native rhythm
    • Atrial fibrillation - rate controlled
  • Intermittent V-paced complexes
    • Complexes #3,4,6,10
Axis:
  • LAD - Native complexes
Intervals:
  • Native Complexes
    • QRS - Normal (100ms)
    • QT - 400ms
  • Paced Complexes
    • QRS - Prolonged (140ms)
    • QT - 440ms
Segments:
  • Paced complexes show appropriate discordant change
Interpretation:
  • Rate controlled atrial fibrillation with intermittent v-pacing
What happened ?


The patient had serial ECG's which showed intermittent sinus rhythm and atrial fibrillation with appropriate pacemaker function.
Serial troponins were elevated consistent with a NSTEMI and the patient declined an angiogram preferring on-going medical management of her symptoms.

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.