This ECG is from a 60 yr old male with known haemochromatosis who presented with a 1 week history of intermittent cardiac sounding chest pain.
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- Sinus rhythm
- Sinus arrythmia
- PR – Normal (~180ms)
- QRS – Normal (80ms)
- QT – 370ms (QTc Bazette 390 ms)
- ST Elevation lead II (less than 1mm)1mm>
- P wave notching lead II
- Biphasic P wave lead III
- Non-diagnostic ECG
- Left atrial abnormality
- Note ECG voltage criteria for atrial abnormalities are poorly sensitive for actual chamber enlargement
Cardiac sequela of haemochromatosis
Cardiac effects of haemochromatosis include initial diastolic dysfunction, risk of arrhythmia and subsequent dilated cardiomyopathy.
What happened ?
The patient was admitted under the cardiology team and subsequent angiogram showed:
- Moderate ostial disease
- Diffuse mid-LAD disease
- Severe distal circumflex disease
Follow-up echo showed:
- Normal biatrial size
- Moderate concentric LV hypertrophy
References / Further Reading
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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