Young male found collapsed at home, apparently intoxicated. What does the ECG show?

TOP 100 ECG QUIZ LITFL 012 2

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities

  • Giant T-wave inversions in multiple leads, most prominent in V2-6
  • Marked QT prolongation > 600 ms

Diagnosis

This ECG pattern is characteristic of raised intracranial pressure and is classically seen in the context of massive intracranial haemorrhage, particularly:

  • Aneurysmal subarachnoid haemorrhage
  • Haemorrhagic stroke

Similar ECG patterns have also been reported in patients with raised ICP due to:

  • Large-territory ischaemic stroke causing cerebral oedema (e.g. MCA occlusion)
  • Traumatic brain injury

The differential diagnosis for widespread T-wave inversions and QT prolongation includes myocardial ischaemia (e.g. Wellens syndrome) and electrolyte abnormalities (e.g. hypokalemia). However, neither condition would cause the gigantic “cerebral T waves” seen here.


TOP 100 ECG SERIES


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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