You have been asked to review an ECG for a 57 year old lady who has presented with chest heaviness and intermittent dizzy spells.
She has a background history of Aortic Regurgitation and Marfans. Her BP in both arms is 130/78, RR18, Sats 99% on air BSL 5.8
Her ECG is as below:
- Rate: 60
- Rhythm: Sinus rhythm (note atrial ectopics in complex 5 and 10)
- Axis: Normal 0-90
- Morphology: STD 0.5-1mm V1-V4, bifid p wave, biphasic -ve +ve T wave in III and aVF, u wave
- Intervals: PR 180 (excluding atrial ectopics with PR 40) QRS 110
- Summary: With history and ECG need to exclude posterior MI
- Investigations Bedside: Serial ECGs including posterior leads, VBG (check Hb in case of aortic dissection)
- Bloods: FBC, U+Es, LFTs, Trop
- Imaging: CXR, CT Aortogram (given chest pain and Marfans history)
- GTN +- opiates
- Withold ASA and antiPLT whilst waiting CT
Further Reading Textbook –
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.