Wednesday, 5 September 2012

ECG of the Week - 3rd September 2012 - Interpretation

This ECG is from a 64 year old with chest pain.







Click to enlarge
 
Rate:
  • 51
Rhythm:
  • Regular Sinus Rhythm
 Axis:
  • Normal (+30 deg)
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (~80ms)
  • QT - 460ms (QTc Bazette ~ 420 ms)
Segments:
  • ST Depression V1-4
  • ST Elevation ~1mm V6
  • T Inversion V1, aVR
 Additional:

  • Inverted P waves I, II, III, aVF, V5-6
  • Positive P wave aVR
  • U waves V2-5

Interpretation:

  • ST Depression in Antero-septal leads
  • ST Elevation in lateral precordial lead
  • Need to consider Posterior Infarction given above findings
  • Ectopic Atrial Rhythm

ECG with Posterior Leads (V7-9 replacing V4-6) was performed and is shown below.
Click to enlarge
  • ST Elevation in Posterior Leads V7-9 (~1mm V7-8)
  • Note P wave abnormalities in initial ECG have resolved

References / Further Reading
 

Life in the Fast Lane

  • Posterior STEMI here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.