ECG of the Week 22nd September 2021

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

Describe and interpret the ECG


Rate: 42 beats/min

Rhythm: No P waves, irregular

Axis: Normal


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


-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


  • 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