22 year old female presents with sudden onset of severe occipital headache

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Rate:

Rhythm:

  • Sinus Rhythm with sinus arrhythmia

Axis:

Intervals:

  • PR – Normal (~160ms)
  • QRS – Normal (80ms)
  • QT – 440-480ms (QTc Bazett ~ 420 ms)

Additional:

  • Deep T wave inversion V2-6, I, II, III, aVF
  • Positive T wave aVR
  • Positive deflection terminal portion T waves – ? TU fusion best seen precordial leads

CLINICAL OUTCOME

In clinical setting of severe headache and widespread T wave changes this is concerning for raised intracranial pressure (ICP) – in this case ?subarachnoid haemorrhage ?intracranial bleed

The patient had a normal CT scan and was transferred to a tertiary center for further investigation and management of other co-morbidities.

Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |