Wednesday, 19 June 2013

ECG of the Week - 17th June 2013 - Interpretation

This ECG is from a 62 yr old male c/o chest pain for 2 hours




Click to enlarge


Rate:
  • Mean Ventricular Rate ~78 bpm
Rhythm:
  • 1:1 Sinus complex :  PVC
    • Bigeminy
Axis:
  • Sinus complex
    • Normal (~10 deg)
  • PVC
    • Normal (~60 deg)
Intervals:
  • Sinus complexes
    • PR - Normal (~160ms)
    • QRS - Normal (100ms)
    • QT - 480ms
  • PVC's
    • QRS - Prolonged (160ms)
    • QT - 420ms
Segments:

  • 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


Additional:

  • Loss R wave progression precordial leads
  • Deep pathological Q waves leads aVL, V1-V6


Interpretation:


  • Marked anterior-lateral ST Elevation MI
  • Bigeminy


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
Thanks to all our commenter's this week, universal agreement on the ECG findings, and welcome to some new commenter's on the blog.


VAQ Corner

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

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