Wednesday, 9 January 2013

ECG of the Week - 7th January 2013 - Interpretation

This is one of the older ECG's I have in my collection, and it didn't come with any clinical information, sorry.


Click to enlarge

Rate:
  • 78
Rhythm:
  • Regular
  • Sinus Rhythm

Axis:
  • Normal (+45 deg)
Intervals:
  • PR - Normal (~200ms)
  • QRS - Normal (80-100ms)
  • QT - 360ms (QTc Bazette ~ 400 ms)
Segments:
  • Slight ST Elevation Lead II
  • ST Elevation V2-3 (~1mm)
  • ST Elevation V4 (Variable magnitude with wandering baseline)

Additional:
  • T Wave Inversion Leads I, aVL
  • T Flattening V6
  • Positive T wave V1
  • Biphasic T waves V2-V4
 


Interpretation:

  • Type 2 Wellen's Pattern
  • High lateral ischaemic changes
  • Anterior ST elevation

  • Patient requires urgent cardiology consultation given high likelihood of critical LAD lesion., and risk of anterior wall AMI.
  • Read more about Wellen's from these resources below.

References / Further Reading
 
Life in the Fast Lane

  • Wellen's Syndrome here
Dr Smith's ECG Blog


Article
  • Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med. 2002 Nov;20(7):638-43. PMID: 12442245 Full text here
  • Mead NE, O'Keefe KP. Wellen's syndrome: An ominous EKG pattern. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 206–208.  Full text here.

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