Wednesday, 13 August 2014

ECG of the Week - 11th August 2014 - Interpretation

This ECG is from an 80 yr old male who presented with a 1 weeks worth of chest pain.
Complex past medical history with significant cognitive impairment. Multiple medications but nil sodium channel blocking agents.
Check out the comments on our original post here.


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Rate:
  • 78
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~200ms)
  • QRS - Normal (80ms)
  • QT - 340ms (QTc Bazette 390 ms)
Segments:
  • Up-sloping ST elevation V2-4
Additional:

  • Biphasic T wave leads V2-4
  • T wave inversion lead I, aVL
Interpretation:
  • Wellens' pattern T wave / ST changes
What happened ?

The patient had raised ischemic biomarkers, however given the severity of his co-morbidities nil further intervention was performed.
An ECHO showed concentric left ventricular hypertrophy with posterior wall akinesis.

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.