ECG of the Week: ECG of the Week - 27th April 2015

Sunday 3 May 2015

ECG of the Week - 27th April 2015 - Interpretation

Some old ECG's from my collection for this week. These ECG's are from an 80 yr old female who presented with pre-syncope. The three ECG's were performed over the course of an hour. Check out the comments on our original post here.

ECG 1
Click to enlarge

Rate:

54 bpm

Rhythm:

Irregular
No clear P waves
Single ventricular ectopic seen in leads V1-3

Axis:

Normal

Intervals:

QRS - Prolonged (120ms)

Segments:

ST Elevation lead aVR, V1-2
ST Depression leads I, II, V4-6

Additional:

T wave inversion leads I, aVL
LBBB like Morphology

QRS >120ms, Deep S wave leads V1-2, Broad R wave in lead I

ECG 2
Click to enlarge

Rate:

48 bpm

Rhythm:

Irregular
No clear P waves
Single ventricular ectopic now seen in leads V4-6

Axis & Intervals

Unchanged

Segments:

ST Elevation lead aVR, V1-2
ST Depression leads I, II

Unable to comment on native activity in leads V4-6 due to only partial complex included

Additional:

Possible U wave in leads V2-3
T wave inversion leads I, aVL
LBBB like Morphology

QRS >120ms, Deep S wave leads V1-2, Broad R wave in lead I

ECG 3
Click to enlarge

Rate:

78 bpm

Rhythm:

Irregular
No clear P waves

Axis & Intervals

Unchanged

Segments

ST Elevation lead aVR, V1-3
ST Depression leads I, II, aVL, V4-6

Additional:

Possible U wave in leads V2-3
T wave inversion leads I, aVL
LBBB like Morphology

QRS >120ms, Deep S wave leads V1-2, Broad R wave in lead I

Key Features

Variable rate AF

From bradycardia to rate controlled

Dynamic ST segment changes comparing ECG 3 with the others ST segment changes appear more pronounced

I don't have any further information on this case but there are a broad general list of differentials for these ECG features including:

Ischaemia

Sinus Node Dysfunction

Electrolyte abn

Drug effect especially digoxin

Drug toxicity including digoxin, CCB, beta-blocker

Endocrine – hypothyroid

Environmental - hypothermia