ECG of the Week – 2nd September 2020 – Interpretation

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A 80 year old lady presents to ED complaining of chest pain and feeling light headed

Rate: Ventricular rate 42 beats per minute, Atrial Rate 114 beats per minute

Rhythm: High grade AV block 3:1

Axis: Normal Axis

Intervals

  • PR Complexes 2,4,6 (only complexes where P wave associated with QRS) PR is 240ms
  • QRS Complexes 2,4,6 100ms, Complexes 1,3,5,7 110ms (slightly longer and shorter than even complexes)
  • QTc 425ms

Additional:

  • P waves mapped in red on ECG
  • Complexes 1,3,5,7 are likely junctional escape complexes that are slightly wider and shorter due to super imposed P wave.
  • With every QRS there are 3 P waves – high grade AV block 3:1
  • Rhythm strip – the patient has gone into ventricular standstill

With ventricular standstill, management of this patient would include start of standard ALS treatment with pacing to be started as soon as possible. Pacing initially can be the form of electrical or medical pacing until plan is made for a PPM

Thank you to Dr Prathibha Shenoy and Dr John Larkin for their input in the interpretation of this ECG