Wednesday, 16 July 2014

ECG of the Week - 14th July 2014 - Interpretation

This week's ECG is from a 67 yr old male who presents with 2 hours of chest pain with associated dysponea and nausea.
Check out the comments on the original post here.




Click to enlarge
Rate:
  • ~65 bpm
Rhythm:
  • Sinus Arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Normal (~180ms)
  • QRS - Normal (100ms)
  • QT - 360ms (QTc Bazette 375 ms)
Segments:
  • ST Elevation leads I (1mm), II (4-5mm), III (3mm), ,aVF (4mm), V4 (2mm), V5 (2.5mm), V6 (3mm)
  • ST Depression leads aVR, aVL, V1-3
    • Flat ST depression V1-2
Additional:
  • Dominant R wave leads V2-3
Interpretation:

  • Infero-lateral-posterior STEMI

What happened ?

The patient was taken for urgent angiography and PCI which showed:

  • Left main - normal
  • LAD - normal Diagonal branch- 90% occlusion
  • Circumflex - OM1 90% & mid LCx 100% occlusion
  • RCA - mild disease only

The circumflex lesion was stented and subsequent Echo showed:

  • Normal LV size & systolic function
  • Normal RV size & systolic function
  • No valvular dysfunction

The patient made an uneventful in-patient recovery and was discharged for out-patient follow-up.

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.