ECG Case 102

22 year old female presents with sudden onset of severe occipital headache


Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Rate:

  • 54

Rhythm:

  • Sinus Rhythm with sinus arrhythmia

Axis:

  • Normal (-14 deg)

Intervals:

  • PR – Normal (~160ms)
  • QRS – Normal (80ms)
  • QT – 440-480ms (QTc Bazett ~ 420 ms)

Additional:

  • Deep T wave inversion V2-6, I, II, III, aVF
  • Positive T wave aVR
  • Positive deflection terminal portion T waves – ? TU fusion best seen precordial leads

CLINICAL OUTCOME

In clinical setting of severe headache and widespread T wave changes this is concerning for raised intracranial pressure (ICP) – in this case ?subarachnoid haemorrhage ?intracranial bleed

The patient had a normal CT scan and was transferred to a tertiary center for further investigation and management of other co-morbidities.


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Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |

2 Comments

  1. Hi, anyone know the relationship of diffuse t wave inversion with the raised ICP? why it happens?
    Thanks

  2. hi! just a small question. Why would you perform an EKG on a patient with severe occipital headache? i mean, it’s more useful to make a head CT or maybe an eye exam on physical examination. Just wondering which was the motive of doing that EKG.

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