Friday, 21 September 2012

ECG of the Week - 24th September 2012

This ECG is from a 55 year old with chest pain.

Click to enlarge


  1. Rhythm: sinus tachycardia at 120 bpm with a complete heart block and a junctional escape at 50 bpm. A rhythm strip would help determine if there were capture at any point, but I doubt it as the R-R remains very regular.

    Interpretation: Inferior wall myocardial infarction (ST-E II/III/aVF/V6, ST-D I/aVL) with possible posterior involvement (ST-D V2-V4). Likely proximal RCA occlusion (ST-E III > II).

    The efficacy of this patient's junctional rhythm is going to determine whether pacing gets utilized. I doubt atropine will help as it appears there is little vagal mediation of the sinus rate.

  2. Christopher,

    I agree with the junctional escape...
    I am having trouble marching the P waves out to be regular sinus at 120 bpm...

    The last four P waves of the strip seem to do just that, but they don't seem to match those at the beginning of the strip. Thoughts?

  3. Dave B,

    I noticed the same thing, they roughly marched out. Perhaps ventriculophasic sinus arrhythmia?