ECG of the Week – 17th September 2018 – Interpretation

The following ECG is from a 72 year old female who presented to the Emergency Department complaining of dizziness. She has a history of ischaemic cardiac disease, atrial fibrillation and diabetes.



Click to enlarge


    Rate:

    • 36 bpm

    Rhythm:

    • Regular ventricular rhythm
    • Atrial fibrillation best appreciated in leads V1-2
      • Irregular atrial activity
      • Absence of P waves

    Axis:

    • Normal

    Intervals:

    • QRS – Normal 

    Additional:

    • T wave inversion leads II, III, aVF, V1-4

    Interpretation:

    • ‘Regularised’ Atrial fibrillation
    • AF + Complete heart block
      • AF – baseline irregularity, no P waves, history of same
      • Complete heart block – regular junctional escape rhythm

    What happened ?

    The patient was not taking digoxin, a common cause of regularised AF, and failed to respond to isoprenaline. She was taken for urgent PPM insertion and following made an uneventful recovery.

    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.

    Powered by WPeMatico