This post is an interpretation of the ECG Case 205
- Rate: ~42 bpm
- Rhythm:
- Regularly irregular
- Complexes occurring in paired group
- Flat baseline without atrial activity
- Regularly irregular
- Axis:
- 1st Complex in pair
- Normal (70 deg)
- 2nd Complex in pair
- LAD(-45 deg)
- 1st Complex in pair
- Intervals:
- 1st Complex in pair
- QRS – Normal (80ms)
- QT – 520ms
- 2nd Complex in pair
- QRS – Normal in limb leads, Prolonged in V1-3 (80-120ms)
- QT – 440ms
- 1st Complex in pair
- Segments:
- 1st Complex in pair
- ST Depression in leads II, aVF
- 2nd Complex in pair
- Minimal ST elevation in lead aVR
- 1st Complex in pair
- Additional:
- 1st Complex in pair
- T wave inversion in II, III, aVF
- Biphasic T in lead V3
- 2nd Complex in pair
- RsR’ Morphology in V1-3
- Inverted notching terminal portion QRS in II, III, aVF also positive notching in aVL
- ? Retrograde P waves ? Secondary to conduction delay
- 1st Complex in pair
Interpretation
Escape bigeminy in setting of sinus arrest / sinus exit block
Differential of causes:
- Ischaemia
- Electrolyte disturbance
- Acid-base disturbance
- Cardiotoxic drugs
- Sinus node dysfunction
- Hypothermia
- Multifactorial combination of above
What happened next ?
Bloods showed:
- Acute on chronic renal failure
- Metabolic acidosis – pH 7.0 Bicarb 7.0
- K 6.0
Therapy with isoprenaline, sodium bicarb, cessation of cardiotoxic medication, and dialysis.
Following acute episode found to have sinus pauses on telemetry necessitating pacemaker insertion.
READ MORE: ECG Interpretation: All you need to know
