This post is an answer to the ECG Case 278
- Rate: 108 bpm
- Rhythm: Irregular
- Axis: RAD
- Intervals: QRS – Prolonged (120-140 ms)
- Segments:
- ST Elevation in leads I, aVL, V1-4
- ST Depression in leads II, III, aVF, V5-6
- Appropriately discordant to QRS vector
- Sgarbossa negative
- Additional: Fibrillation waves noted in lead V2
Interpretation
- Atrial fibrillation
- LBBB
Considerations in an elderly febrile patient are:
- Is the AF long-standing or secondary to concurrent illness?
- What medication is the patient already on? Especially anti-arrhythmic agents and anti-coagulation.
What happened ?
The patient had longstanding atrial fibrillation / flutter and was on long term anti-coagulation and beta-blocker therapy. Prior echo showed severe systolic dysfunction, ejection fraction 38%, due to prior ischaemic insult in the LAD territory with severe mitral regurgitation. The left atrial was also severely dilated.
The fever and abdominal pain were due to acute cholecystitis and the patient was admitted to the hospital with both cardiology and surgical input for management of her condition.
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