ECG of the Week 12th October 2022 Answer

Posted on by

A 58 year old male presents to ED complaining of a headache and weakness to his left side. The following ECG is obtained:

Describe and interpret the ECG

Answer

Rate: 54 beats per minute

Rhythm: Regular sinus rhythm

Axis: Normal Axis

Intervals

  • PR: 186ms
  • QRS: 100ms
  • QTc: 493 msec (Bazett)

Additional:

Deep symmetrical T wave inversion laterally and lead II

ST elevation V1 and aVR

ST depression lateral leads

Voltage criteria for LVH SV1 + RV6 = 40mm and SaVR = 16mm

The above ECG shows a sinus bradycardia, with a prolonged QT interval and deep symmetrical T waves and some ST changes. The ECG also meets voltage  criteria for LVH. Non voltage criteria for LVH usually cause asymmetrical T wave inversion.

Differential diagnosis for this ECG in this clinical context includes raised intracranial pressure, ischaemia and apical hypertrophic cardiomyopathy

Raised intracranial pressure can cause a wide range of changes on ECG, including:

QT prolongation and T wave inversion

ST elevation

Arrythmias

This patient had a hypertensive thalamic bleed. There was no old ECG’s to compare to, but LVH changes would be consistent with chronic hypertension. The T wave inversion is likely due to raised intracranial pressure, but echo would need to exclude apical cardiomyopathy.