Name that ECG: 66 year old female – Findings

This is the conclusion to our Name that ECG case: 66 year old female, resolved chest pain.

66 year old female, resolved chest pain.

Name that ECG: 66 year old female

 

Rhythm:

  • Rate: atrial rate of ~55 bpm, ventricular rate of ~55 bpm
  • Regularity: regular
  • P-waves: sinus (upright in I and II), associated 1:1 with the QRS
  • PRi: 140 ms
  • QRS duration: 90 ms

Bonus points:

  • Axis: -45 degrees, left axis deviation, LAFB
  • Bundle Branches: normal conduction
  • QTc: normal (<1/2 R-R interval), 420 ms (Bazett's Formula)
  • ST/T-waves:
    • T-waves: flipped T-waves in aVL, biphasic V2-V5 consistent with Wellen's Syndrome
    • ST-elevation: none noted
    • ST-depression: none noted

Differentials:

  • Normal sinus rhythm in a patient with Wellen's Syndrome
    • Possible high-grade stenosis of the LAD with recent reperfusion

Notes:

  • Wellen's Syndrome should be regarded with the same importance as a STEMI during assessment and transport.

1 Comment

  • VinceD says:

    If you wanted to really push the limits of this ECG I also see inverted inverted U-waves in leads V2-V4, I, and aVL. They're super faint and I wasn't sure if I believed them at first, but measuring from the QRS to the U wave in III and aVF and transposing that interval to the other leads proves that it's really them.

    They don't add any information the T-waves don't tell you here, but heck, they're there.

    And now I'm really being a pain, but I think calling a LAFB is being a little generous to that LAD.  By my eye I put the axis, at most, at around -40 degrees. There's also no well developed rS complexes in II and aVF and the tracing lack the poor R-wave progression I usually see in true LAFB's. There doesn't seem to be an accepted criteria for making the Dx, but this one seems to be pushing it.

Leave a Reply

Your email address will not be published. Required fields are marked *

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Erich
What it Looks Like: Cardiac Arrest
Fantastic post, must see stuff for junior paramedics, medical students, residents and nurses that could potentially see cardiac arrest on a regular basis.
2014-11-25 16:22:28
LITFL Review 156
83 Year Old Male: Shortness of Breath
[…] ischaemia? Check out this case from the EMS 12 Lead blog. For more effective learning, read the original case first. […]
2014-11-25 09:09:03
ECG Axis Interpretation
The 360 Degree Heart – Part I
[…] http://www.ems12lead.com/2014/09/11/the-360-degree-heart-part-i/ […]
2014-11-25 09:01:37
LITFL Review 152 - LITFL
The 360 Degree Heart – Part I
[…] you understand axis as well as you’d like? The EMS 12-Lead blog gives us the first in a new series on understanding axis on the ECG. […]
2014-11-25 08:55:15
The LITFL Review 140
Conclusion to Masters Case #02
[…] out the conclusion to an extremely challenging EKG case from the EMS 12-Lead blog. For maximum learning, read part one first. […]
2014-11-24 20:43:03

STEMI Expert?

  • Click here to find out!
  • 12-Lead ECG Challenge Smartphone App

    Photobucket

    12-Lead ECG Challenge Smartphone App - $5.99

  • Apple iOS
  • Android
  • Amazon
  • Web Based

  • FRN-TV video review
  • iMedicalApps.com review
  • Interested in resuscitation?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    Visitor Map / Stats

    Locations of visitors to this page


    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS