ECG of the Week – 8th October 2018 – Interpretation

This ECG is from a 50 yr old female who presented complaining of palpitations for the last few hours. She has no past medical history and takes no regular medications.





Click to enlarge

Rate:

  • 156 bpm

Rhythm:

  • Regular
  • Atrial activity very difficult to see
    • Potential P wave visible in lead I just after T wave
    • Very low voltage
    • Not always appreciable

Axis:

  • Normal

Intervals:

  • QRS – Normal 

Additional:

  • Inferior ST depression
  • T waves broad in leads II, III, aVF, V3-6

Interpretation:
Challenging ECG in terms of the rhythm, three possible DDx:

  • Sinus tachycardia
  • Atrial tachycardia
  • Atrial flutter 2:1 block

Below is the rhythm strip with some of the possible atrial complexes highlights with a red square.




Click to enlarge

A few helpful strategies would be to:

  • Alter paper speed, gain and rhythm strip lead
  • Use a Lewis lead configuration
  • Treat the patient – Sx treatment, seek and treat potential causes, consider adenosine


Lewis Lead


The Lewis lead configuration was first described in 1931 and uses a modified lead placement to assist in the identification of atrial activity. 

You can read more about the Lewis lead and how to perform it in the links below:

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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