Wednesday, 11 December 2013

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

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