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.