ECG of the Week – 11th February 2019 – Interpretation

The following ECG is from a 70 year old female who was referred by her GP following an episode of chest pain.


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Rate:

 

  • 72 bpm

Rhythm:

 

  • Regular
  • Sinus rhythm 

Axis:

  • Normal (-30 deg)

Intervals:

  • PR – Normal (~160ms)
  • QRS – Normal (100ms)

Additional:

  • Flat lead II – near isoelectric
  • Complete reversal leads III, aVF
    • T inversion
    • Negative QRS
    • Negative P waves – low voltage
  • Prominent T wave lead V2
  • ST depression leads V5-6

Interpretation:

  • Multiple abnormalities in limb leads
    • Secondary to complex lead reversal – not typical of paired lead swap
  • Prominent T wave in lead V2 with ST depression in lateral leads 

What happened ? A repeat ECG with correct lead position resulted in resolution of all limb lead abnormalities and unchanged non-dynamic precordial lead changes.Serial cardiac biomarkers were negative and the patient was discharge.

 

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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