EKG (ECG) INTERPRETATION

Clinical Picture

• 80-year-old female presenting with a two-day history of diarrhoea and vomiting
• Previous cardiac issues noted, with extensive past medical history,
• Looks tired and anxious.

Findings

• Rate: 75
• Rhythm: Regular
• Axis: Normal
• Waves and intervals: No abnormality

Summary 

• The EKG shows bradycardia with symmetrically peaked T waves.

Differential diagnosis

• In an elderly patient with a background of cardiac issues, presenting after a period of diarrhoea, vomiting and severe thirst, peaked T waves on an EKG indicate a differential of hyperkalemia secondary to dehydration.  Myocardial infarction would give a dull, heaviness and central chest pain.  A pneumothorax tends to present with sharp pain, shortness of breath and the patient may have unequal breath sounds on examination. Pericarditis is likely to present over a period of more than two days, and there is no evidence of GI reflux symptoms.

Management

• In this case, rehydration and reassurance are needed.

Further reading

• EKG (ECG) Interpretation Guide

References

1. Wagner, P., Strodthoff, N., Bousseljot, R., Samek, W., & Schaeffter, T. (2020). PTB-XL, a large publicly available electrocardiography dataset (version 1.0.1). PhysioNet
2. Wagner, P., Strodthoff, N., Bousseljot, R.-D., Kreiseler, D., Lunze, F.I., Samek, W., Schaeffter, T. (2020), PTB-XL: A Large Publicly Available ECG Dataset. Scientific Data
3. Goldberger, A. et al. (2000). PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation [Online]. 101 (23), pp. e215–e220.