ECG of the Week - 22nd June 2015 - Interpretation

This ECG is from a 75 year old female who presented with 1 hour of central chest pain.
She had recently been hospitalized for a NSTEMI and had 2 drug-eluting stents inserted to her mid RCA.
Check out the comments from our original post here.

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Rate:

• ~66 bpm

Rhythm:

• Regular
• Likely sinus although P waves are difficult to see

Axis:

• Normal

Intervals:

• QRS - Normal (100ms)
• QT - 400ms (QTc Bazette 380-400 ms)

Segments:

• Marked ST Elevation leads II, III, aVF, V1, V2-6
• ST Depression leads I, aVL

Interpretation:

• Inferior STEMI
• Likely RV involvement given STE III>II and STE in V1
• Antero-lateral ST elevation

What happened ?

The patient was taken for emergency coronary angiogram and PCI which showed:

• Heavy thrombus burden in the RCA stent

The patient made an uneventful recovery and had alteration to his anti-platelet medication.

3rd Universal Definition of Myocardial Ischaemia - Classification of MI

I'd recommend anyone dealing with patient's suffering from, or likely to suffer from myocardial ischaemia to have a look at the '3rd Universal Definition of Myocardial Ischaemia'. One interesting section is the classification system for myocardial ischaemia as it acts as a nice reminder that not all ischaemia is due to blocked native vessels.

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References / Further Reading

Life in the Fast Lane

• Inferior STEMI
• RV STEMI

Textbook

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