ECG of the Week - 9th December 2013 - Interpretation

This week's ECG is from a 58 yr old male who presents to the Emergency Department c/o palpitations, dizziness, and chest pain. Symptoms onset ~90 mins prior to presentation.Past Hx - hypertension, hyperlipidaemia.
Check out the comments on our original post here.

Click to enlarge

Rate:

• Mean rate ~130bpm

Rhythm:

• Irregular
• Nil p waves

Axis:

• Normal 

Intervals:

• PR - Nil p waves
• QRS - Normal (80ms)
• QT - 280ms

Segments:

• ST Elevation leads II (4mm), III (5mm), aVF (4mm), V4 (2mm), V5 (3mm), V6 (2.5mm)
• ST Depression leads aVL, aVR, V1-2 (note horizontal morphology)

Additional:

• Prominent R wave V1-2

Interpretation:

• Infero-lateral-posterior STEMI
• Atrial Fibrillation
• Whilst there is a suggestion there may be group beating both our blog electrophysiologists have reviewed the ECG and agree this is 'simple' atrial fibrillation

What happened ?

The ECG findings were immediately recognised and local PCI protocol was activated.
The angiogram showed:

• LAD - 70% mid-stenosis
• PLA - 100% ostial occlusion --> Stented
• LV function preserved

Echocardiogram:

• Inferolateral LV akinesis
• Normal RV size and function

The patient's recovery was complicated by acute stent thrombosis requiring re-stent. He was discharge following a 4 day in-patient stay.

References / Further Reading

Life in the Fast Lane

• STEMI Inferior here
• STEMI Lateral here
• STEMI Posterior here
• STEMI RV here

Textbook

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