Wednesday, 10 April 2013

ECG of the Week - 8th April 2013 - Interpretation


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




Click to enlarge


Rate:
  • ~108 bpm
Rhythm:
  • Irregularly irregular
  • Sinus rhythm
  • Frequent PVCs
    • Unifocal
    • Single & Couplets
    • Evidence of compensatory pauses
Axis:
  • Sinus Complexes - Normal (+70 deg)
  • PVC - LAD
Intervals:
  • PR - Normal (~180ms)
  • QRS - Sinus Complexes - Normal (100ms)
  • QRS - PVCs - Prolonged (120-140ms)
  • QT - 320ms (QTc Bazette ~ 420 ms)
Segments:

  • ST Elevation Leads
    • II (1mm),III (2mm), aVF (3mm)
    • ? V6 (0.5mm) - single complex with uneven baseline
  • ST Depression  Leads aVL, V1-3

Additional:

  • T wave inversion aVR, aVL, V1-3
  • P wave inversion Leads aVR, V1-2
  • R wave V1-3
  • PVCs - Discordant T wave & ST segment changes

Interpretation:

  • Acute STEMI
    • Inferior with ? postero-lateral involvement
This is an older case from my ECG collection but the clinicians looking after this patient were concerned about possible right ventricular involvement as an ECG with partial right precordial leads, V3-5R, was performed which is below:


Click to enlarge


There is no evidence for ST elevation in the right sided leads making RV involvement very unlikely. I don't know if posterior leads were performed, I don't have a posterior lead ECG from this case.

What happened ?

This is an older case from early 2012 but I managed to get some information on the ultimate outcome.

The ECG features were immediately recognized and STEMI protocol was activated.
The patient underwent an uneventful transfer for PCI which revealed a 100% occlusion of the proximal RCA which was stented.

The patient was commenced on aspirin, prasugrel, statin, ACE, and beta-blocker therapy. 
He was discharged after a 3 day in-patient stay.


References / Further Reading

Life in the Fast Lane

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