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.
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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

• Inferior STEMI
• Lateral STEMI
• Posterior STEMI

Textbook

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