ECG case series for paramedics: May 2023

A 77-year-old lady who normally keeps fit and well first developed chest discomfort at rest several days ago. This resolved spontaneously and she presumed it to be indigestion. This morning, she was aware of a discomfort in her central chest on awakening. While showering an hour later, the discomfort intensified and was now quite painful. She described it as being heavy in nature. She was aware of it radiating to both upper arms and through to her back. She also described a ‘fluttering’ in her chest and an awareness of her own heartbeat.

These symptoms were still present an hour later and she called her GP practice. An ambulance was mobilised. As part of the crew's assessment, the 12-lead electrocardiogram (ECG) in Figure 1 below was recorded.

This rhythm is atrial fibrillation (AF). AF is the most common sustained abnormal heart rhythm (arrhythmia) that health professionals will encounter (National Institute for Health and Care Excellence (NICE), 2014). It is typically detected as irregular pulse or an irregular rhythm on an ECG (NICE, 2021).