ECG of the Week – 7th July 2021 – Interpretation

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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:

Interpretation:

  • 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

Management:

  • 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)

Treatment

  • 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.