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

• Atrial fibrillation
• Pacemakers 

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.