A 50 year old male presents to ED after being found in a park. Below is the patients ECG:

Describe and interpret the ECG

Answer:

Rate: 42 beats/min

Rhythm: No P waves, irregular

Axis: Normal

Intervals

• PR –
• QRS  Prolonged >200ms
• QTc 500ms

Additional:

-notching of QRS – Osborne wave

-T wave inversion and ST depression inferolaterally

-Artefact baseline

The above ECG shows an irregular very broad based bradyarrhythmia. DDx for this includes

• severe hyperkalaemia
• Na channel blockade
• hypothermia – most likely in this case as the ECG is a slow AF with Osborn waves

References

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

Thank you Dr John Larkin – ECG stolen from Dr John Larkins ECG of the Week Blog