ECG Case 115

The following ECG is from a 71yr old male who presented with several episodes of ischaemic sounding chest pain on a background of known ischaemic cardiac disease.

ECG Case 115 LITFL Top 100 EKG

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Rate:

  • Mean rate 66 bpm

Rhythm:

  • Sinus rhythm
  • Unifocal PVCs

Axis:

  • Normal

Intervals:

  • PR – Normal (~200ms)
  • QRS – Prolonged (120-130 ms)
  • QT – 410ms (QTc Bazett 470 ms)

Additional:

  • QRS fragmentation 
    • Best seen leads V2-3
    • Lead V2 rsr’s’r”s” pattern
    • Lead V3 rsr’s’ pattern
  • T wave inversion leads V4-5
  • ST elevation leads aVR and aVL (< 1mm)<1mm font=””>
  • ST depression leads II, III, aVF

Interpretation:

  • ST and T wave changes
    • Likely ACS given history 
    • Needs serial ECGs and comparison with prior ECGs
  • QRS Fragmentation
    • Caused by abnormal ventricular repolarisation
    • Due to myocardial scarring, fibrosis or ischaemia

CLINICAL OUTCOME

QRS Fragmentation

The two following papers are a great overview of QRS fragmentation including diagnostic morphology and clinical relevance in terms of associations and effects on morbidity and mortality.

Further reading:


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

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