ECG of the Week - 23rd January 2016 - Interpretation

The following ECG is from a 86yr old male who presented to the Emergency Department following an episode of syncope.

Click to enlarge

Rate:

• Ventricular rate 48 bpm
• Atrial rate 72 bpm

Rhythm:

• Repeating pattern
• Atrial activity with pr prolongation ~330ms
• Sinus ventricular beat
• Progressive PR prolongation ~440ms
• Narrow QRS
• Junctional escape vs sinus beat
• Notching in terminal QRS likely superimposed P wave
• Pause

Axis:

• Normal

Intervals:

• PR - Progressive prolongation
• QRS - Normal

Segments:

• ST Depression II, aVF, V4-6

Additional:

• Prominent anterior T waves
• Broad notched P wave in lead II
• Left atrial abnormality

What happened ?

The patient was admitted for cardiac monitoring and cardiology review. Continuous cardiac monitoring showed intermittent 2nd Degree Wenckebach AV Block and bradycardia. The patient was offered a PPM and declined. There were no identifiable reversible cause including drug toxicity, electrolyte abnormality, myocarditis or ACS.

References / Further Reading

Life in the Fast Lane

• 2nd Degree AV Block - Type I Wenckebach
• P wave morphology

Textbook

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