A weekly ECG / EKG review blog looking at some interesting ECG's from the world of Emergency Medicine.
Asia represent!!!Whoa.. much badness.Inf MI with post extension and non sustained VT.Get pads on pt and pt into an angio suite!
Agreed with the above :)In detail:Rate: sinus tachycardia @ ~105Regularity: irregular, frequent PVCs interruptingP-waves: sinusPRi: 160ms, associated 1:1QRSd: 110msRhythm: sinus tachycardia with frequent short-coupled PVCs and couplet PVCs. Axis: normalQTi/QTc: normalST/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.
Here is my attempt:Rate- difficult to determine but approximately 96 bpmSome sinus beats and others ectopic in originNormal axis PR intervals-normal when presentQRS- normal duration when preceded by a p wave. Widened 0.24 sec when ectopic in origin QT normal durationST elevation of 1mm in leads II, III and aVFST depression in aVL or 2mmMarked T wave inversion in leads V1,V2 and V3Negative p waves in V1Interpretation 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
ECG of 52 yo man with chest painDescription========Rate: approximately 100bpmRhythm: sinus, regularly irregular intervened by wide complex QRS, resembling non-sustained VTsAxis: normalP: normal height and morphology, 1:1 P:QRS ratio. PR interval 160msQRS: <100ms, narrow complexes on rhythm strip, however frequently intervened by broad complexes QRS, non-sustained VTs. No fusion/capture beat present. No AV dissociation presentST: 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 confirmQT: roughly 400ms uncorrected. No hyperacute Ts presentSummary======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 PTCAIf deteriorate into sustained VT/VF, manage accordingly to ACLS guidelines
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 ...