You are reviewing the ECG of a 65 year old man who has presented with a one week history of chest tightness and shortness of breath. He has a background history of Type 2 Diabetes and had x2 coronary stents 5 years prior.
Interpretation:
- Rate: 84
- Rhythm: Sinus rhythm (p wave most easily seen in V2 where artefact is less obstructive)
- Axis: Normal (0-90)
- Morphology: low amplitude interference seen throughout all leads, relative sparing of V2
- Intervals: PR160 QRS 80
- Summary: Normal ECG with interference.
Causes of interference or artefact:
- Patient Factors: PPM or other implanted devices, movements disorders eg PD, rigors, muscle activity for other reasons eg pain or hypothermia, poor pad contact due to hair or moisture.
- Lead Factors: pads poorly placed or misplaced, damaged or misconnected leads
- ECG machine Factors: inappropriate gain settings, electrical artefact from power supply
- Printing Factors: low ink, paper malaligned, printer head tracking
- External Factors: ie external surroundings causing interference (rare with newer machinery)
Clinical Relevance in this patient:
- At Joondalup the commonest cause of interference is due to artefact from the power supply (solved with turning off the plug and relying on battery power to print an ECG) – but in this instance the artefact remained
- This patient had a spinal cord stimulator which was the cause for the interference seen.
Further Reading -Online
ECG of the Week from Dr Larkins Blog 26th June 2017 – and ECG showing artefact from an implantable neuro-stimulator
(http://jhcedecg.blogspot.com/2017/06/ecg-of-week-26th-june-2017_28.html)
Further Reading – Textbook:
Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.