ECG Case Series for Paramedics: April 2023

02 April 2023
Volume 15 · Issue 4

Apreviously fit and healthy 35-year-old man presented with a seizure. He was out shopping when he felt cold, clammy and faint. He sat down but was then helped to the floor as he became unresponsive. He was vacant for approximately 1–2 minutes with twitching of his legs. There had been no preceding prodromal symptoms such as palpitation. When the paramedics arrived 5 minutes later, he was drowsy but responsive, and complaining of frontal headache. His vital signs were:

  • Blood pressure: 120/65mmHg
  • Pulse rate: 50 beats per minute
  • Respiratory rate: 18 breaths per minute
  • SPO2: 96% on air
  • Temperature: 37.2oC.
  • He was taken to the emergency department. A subsequent computerised tomography (CT) scan showed no abnormality within his brain. A 12-lead ECG was recorded.

    The heart rate is approximately 50 beats per minute and in sinus rhythm. There is left axis deviation.

    The ECG shows some significant abnormalities:

  • The QRS complex is slightly wider than normal
  • The P-R interval is short
  • There is a slurred upstroke of the R wave. This is called a delta wave.
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