ECG of the Week: ECG of the Week - 24th November 2014

Wednesday 26 November 2014

ECG of the Week - 24th November 2014 - Interpretation

This is one of the oldest ECG's I have in my collection and as such I don't have any clinical information on the case other then it's from a 90 yr old female.
So why do we think she ended up in the Emergency Department based on the ECG ?
Check out the comments on our original post here.

Click to enlarge

Rate:

~48 bpm

Rhythm:

Irregular
No p waves visible

Axis:

Normal

Intervals:

QRS - Prolonged (~180ms)
QT - 720ms

Segments:

Inferior ST sagging

Additional:

RBBB Morphology
Osborn J waves
Prominent U waves best seen infero-laterally
T wave inversion leads aVR, aVL, V1-3

ECG with T, U and J waves labelled
Click to enlarge

Interpretation:

Slow Atrial Fibrillation
J-waves
Prominent U waves

Differentials for this ECG

Without more clinical information it's difficult to give a firm conclusion. I think this ECG is most consistent with hypothermia but some features could be explained by drug toxicity (digoxin, CCB's, beta-blockers), electrolyte abnormalities, ischemia, sinus node dysfunction. We should be mindful in the elderly that the clinical situation is often multi-factorial and could be a combination of the above causes. Also remember hypothermia in the elderly has a multitude of potential causes including environmental, sepsis and endocrine.

New Team Member

I'd like to welcome Dr Richard McClelland to our ECG blogging team - Richard is a EM registrar in Australia planning to continue his training back in the UK.

References / Further Reading

Life in the Fast Lane