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.
- ECG Library – Raised Intracranial Pressure
- CCC – Subarachnoid Haemorrhage: Overview
- ECG Library – Wellens syndrome
TOP 150 ECG Series
Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |
3 Comments
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Hi, anyone know the relationship of diffuse t wave inversion with the raised ICP? why it happens?
Thanks
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.
Possibly obtained to assess QTc prior to giving dopamine antagonists as part of migraine cocktail.