Wednesday, 10 September 2014

ECG of the Week - 8th September 2014 - Interpretation

This week's ECG is from a 75 yr old female. Past medical history of GORD. She presented complaining of 3 hours of epigastric pain with severe nausea and multiple episodes of vomiting.




Click to enlarge

Rate:
  • 66 bpm
Rhythm:
  • Regular
  • Sinus rhythm
    • Baseline artifact makes P waves difficult to see but best seen in leads V1-3
Axis:
  • Normal
Intervals:
  • PR - Prolonged (280ms)
  • QRS - Normal (80-100ms)
  • QT - 380ms (QTc Bazette 400 ms)
Segments:

  • ST Elevation leads III, aVF (<1mm)
  • Flat ST depression V1-3

Additional:

  • T wave inversion leads I, aVL, aVR, V1-3
  • Prominent T waves leads III, aVF, V6
  • Prominent R wave lead V2

Interpretation:


  • Infero-postero-lateral MI

What happened ?

The patient had posterior leads performed, ECG below:




Posterior leads show clear ST elevation and the eagle-eye'd among you will notice that leads V1-3 are clearly different from the first ECG.

Our local lead set-up means V1-3 on this ECG are certainly leads V4-6 but haven't been labelled as such. 

The patient was transferred for urgent PCI and a lesion was stented. 

Unfortunately the hospital discharge summary doesn't state where the culprit lesion was !!



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.