ECG of the Week: ECG of the Week - 19th March 2018

Wednesday 21 March 2018

ECG of the Week - 19th March 2018 - Interpretation

The following ECG is from an 85 yr old male who presented with dizziness and an abnormal gait.

Click to enlarge

Rate:

Mean ventricular rate 60 bpm

Rhythm:

Irregular ventricular complexes
Flutter / fib waves best seen in leads aVF & V1

Axis:

Intervals:

QRS - Normal (80ms)

Additional:

Early R wave transition between V1 & V2
Subtle ST depression leads V4-6
Flat T wave lead aVL

Interpretation:

Atrial fibrillation

Rate controlled

Considerations in atrial fibrillation There are a number of things to think about when encountering a patient with atrial fibrillation.

Onset

Acute vs chronic
Duration

Rate disturbance

Rapid ventricular response
Normal rate
Bradycardia - may be secondary to therapy or tachy/brady syndrome

Complication of AF

Cardiac failure
Hypotension
Ischaemia
Thromboembolic / CVA

Current therapy

Anti-coagulation
Anti-arrhythmics
Complications of therapy

Drug toxicity

Bleeding
Precipitant / Causative factors
Infection / Ischaemia / Structural / Endocrine / Metabolic

Despite being one of the commonest arrhythmia encountered in medicine there is considerable variability in the clinical management of atrial fibrillation. There are a number of international guidelines and protocols regarding AF management, including:

AF Related Calculators (links to MDCalc)

What happened ? This patient had known chronic atrial fibrillation and acute presentation was secondary to an acute embolic CVA.
References / Further Reading

Life in the Fast Lane