Wednesday, 22 July 2015

ECG of the Week - 20th July 2015 - Interpretation

This ECG is from a 50 year old male who presented with 10 hours of chest pain.
Background history of hypertension and smoking.
Check out the comments from our original post here.



Click to enlarge
Rate:
  • 90 bpm
Rhythm:
  • Sinus Arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Normal (~200ms)
  • QRS - Normal (100ms)
  • QT - 400ms (QTc Bazette 380-400 ms)
Segments:
  • ST Elevation leads V1 (2mm), V2 (2-2.5mm), aVR (1mm)
  • ST Depression II, III, aVF, V5-6
Additional:
  • Voltage criteria LVH
    • S wave V1 + R wave V5 = 24mm + 14mm = 38mm
  • Left Arial Enlargement

Interpretation:

  • LVH
    • ST changes proportional to S wave voltage
    • ST to S wave ratio <25%
What happened ?


In this case the changes due to LVH were thought to represent acute MI and the patient was taken for urgent angio which was essentially normal.


There are a few nice reviews on LVH and ACS look at decision rules to help distinguish LVH from LVH + acute AMI that I'd recommend:


Also a number of cases from Dr Smith involving LVH:


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.