ECG of the Week – 14th May 2018 – Interpretation

This ECG is from a 68 yr male who presented with 24 hours of dysponea and palpitations.
No past medical history of note and he takes no regular medications.

Click to enlarge

Things to think about

  • What are the key ECG features ?
  • What are the potential reversible causes for these features ?
  • How would you manage this patient ?

Rate:

  • Ventricular rate 42 bpm
  • Atrial rate 84 bpm

Rhythm:

  • Regular atrial and ventricular activity
  • 2:1 AV block

Axis:

  • Normal

Intervals:

  • PR – Normal (~200ms)
  • QRS – Prolonged (140ms)

Additional:

  • RBBB Morphology
  • Prominent T wave lead III in relation to QRS height

Interpretation:

  • 2:1 AV Block

What happened ?

The patient was admitted under the cardiology team and telemetry revealed intermittent variable AV block (2nd and 3rd degree) and he underwent an uneventful dual chamber PPM insertion.

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.

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