|Click to enlarge|
- Mean Ventricular Rate ~78 bpm
- 1:1 Sinus complex : PVC
- Sinus complex
- Normal (~10 deg)
- Normal (~60 deg)
- Sinus complexes
- PR - Normal (~160ms)
- QRS - Normal (100ms)
- QT - 480ms
- QRS - Prolonged (160ms)
- QT - 420ms
- ST Elevation leads aVL, V1-V6
- aVL=2mm V1=2/3mm V2=4mm V3=5mm V4=7mm V5=5mm V6=3mm
- ST Depression leads II, III, aVL
- Loss R wave progression precordial leads
- Deep pathological Q waves leads aVL, V1-V6
- Marked anterior-lateral ST Elevation MI
This patient requires urgent reperfusion therapy, I unfortunately don't have any further clinical information on this case as to the outcome or culprit lesion.
I thought this would be an interesting ECG to share in that it is easy to get confused and distracted by the PVC's when interpreting this ECG, 'not being able to see the wood for the trees'.
To illustrate this I edited out all the PVC's from the ECG, see below, it is now much easier at first glance to see the STEMI pattern, highlighting the need to have a systematic approach to ECG interpretation.
|Same ECG as above with PVC's edited out|
Click to enlarge
An 62 year old male presents to your urban district Emergency Department.
He c/o 2 hours of central chest pain.
Pst Hx hypertension & smoking.
BP 134/72 RR 21 Sats 98% RA T 36.4
His ECG is above.
a) Describe & interpret his ECG ? (100%)
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.