Wednesday, 2 May 2012

ECG of the Week - 30th April 2012 - Interpretation

This weeks ECG is from a 54 yr old with chest pain.






Click to enlarge

Rate:
  • Ventricular rate 50 bpm
  • Atrial rate ~94 bpm
Rhythm:
  • Regular
  • 2:1 Block ? Complete AV Block

Axis:
  • Normal (~90 deg)
Intervals:
  • PR - Prolonged ( 240ms)
  • QRS - Normal (80ms)
  • QT - 360ms (QTc Bazette ~ 330ms)
Segments:

  • ST Elevation leads II (6mm), III (8-9mm), aVF (7mm)
  • ST Depression leads I, aVL, aVR, V1-6

Additional:

  • P wave broadening lead II (120ms)
  • Biphasic P wave V1-2

Interpretation:
  • Inferior STEMI
  • ST Depression V1-3 need to consider posterior extension - leads V7-9
  • ST Elevation in lead III > II need to consider RV infarction - right leads or V4R

  • AV Block - likely 2nd Degree 2:1 block but could be 3rd Degree block

  • Possible Left Atrial Enlargement


  
References / Further Reading

Life in the Fast Lane

  • Inferior STEMI here
  • Posterior STEMI here
  • RV Infarction here
  • 2nd Degree AV Block here
  • 3rd Degree AV Block here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.