ECG Case 102

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

ECG Case 102 LITFL Top 100 EKG

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Rate:

  • 54

Rhythm:

  • Regular
  • Sinus Rhythm

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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