Friday, 5 April 2013

ECG of the Week - 8th April 2013

This ECG is from a 52 year old male presenting with chest pain.

Click to enlarge


  1. Asia represent!!!
    Whoa.. much badness.
    Inf MI with post extension and non sustained VT.

    Get pads on pt and pt into an angio suite!

  2. Agreed with the above :)

    In detail:

    Rate: sinus tachycardia @ ~105
    Regularity: irregular, frequent PVCs interrupting
    P-waves: sinus
    PRi: 160ms, associated 1:1
    QRSd: 110ms
    Rhythm: sinus tachycardia with frequent short-coupled PVCs and couplet PVCs.
    Axis: normal
    QTi/QTc: normal
    ST/T-waves: inferiolateral MI w/ reciprocal changes (or posterior extension). Could be RCA or LCX, I'm leaning towards RCA as III has just a bit more elevation than II.

    DDx: inferior MI w/ likely posterolateral extension leading to R-on-T PVC's placing our patient at a high risk for sustained VT or degeneration into VF. Cath lab would be a solid option, with lytics followed by rescue PCI if E2B/D2B would exceed 90 minute guidelines.

  3. Here is my attempt:

    Rate- difficult to determine but approximately 96 bpm
    Some sinus beats and others ectopic in origin
    Normal axis
    PR intervals-normal when present
    QRS- normal duration when preceded by a p wave.
    Widened 0.24 sec when ectopic in origin
    QT normal duration
    ST elevation of 1mm in leads II, III and aVF
    ST depression in aVL or 2mm
    Marked T wave inversion in leads V1,V2 and V3
    Negative p waves in V1

    Myocardial infarction with ST elevation in the inferior leads with some reciprocal changes in the anterior leads.
    Ventricular origin ectopic beats in singles and couplets, different focuses of ventricular ectopics due to the different morphologies of the ectopic beats.

    In the setting of chest pain then this would warrant urgent cardiac catherisation

  4. ECG of 52 yo man with chest pain

    Rate: approximately 100bpm
    Rhythm: sinus, regularly irregular intervened by wide complex QRS, resembling non-sustained VTs
    Axis: normal

    P: normal height and morphology, 1:1 P:QRS ratio. PR interval 160ms
    QRS: <100ms, narrow complexes on rhythm strip, however frequently intervened by broad complexes QRS, non-sustained VTs. No fusion/capture beat present. No AV dissociation present
    ST: markedly elevated in inferior leads (2,3,AVF). Lead 3 not more than lead 2. Reciprocal ST depression in anterior precordial leads. Presence of AVL ST-depression highly suggestive of posterior extension. Will need R sided ECG to confirm
    QT: roughly 400ms uncorrected. No hyperacute Ts present

    Highly abnormal 12-lead ECG indicating unstable inferior STEMI, with reciprocal changes on AVL and anterior precordial suggestive of posterior extension. Culprit lesion likely RCA/LCx.
    Emergent management needed in view of rhythm instability with intermittent progression to NSVTs. Definitive management would be PTCA
    If deteriorate into sustained VT/VF, manage accordingly to ACLS guidelines

  5. Agree with above. Christopher is 100% on the mark - Acute Infero-postero-lat MI (probable prox RCA occlusion) - frequent PVCs/couplets. Of note - inferior Q waves have already formed. Acute cath lab activation was hopefully done as soon as this ECG was seen ...