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- ~84 bpm
- PR - Prolonged(~220ms)
- QRS - Normal (80-100ms)
- QT - 400ms (QTc Bazette 470-480 ms)
- ST Elevation leads II, III, aVF, V4, V6
- Unusual ST morphology in inferior leads
- ST depression lead aVL, V1-3
- Note complete lead inversion leads I, aVL - negative P/QRS/T
- Lead malposition
- Likely V4 & V5 reversed
- RA / LA limb lead reversal resultant inversion lead I, II/III switched and aVR/aVL switched
What happened ?
The patient was taken for urgent PCI which was normal !
He subsequently went on to have a CT brain which showed an extensive sub-arachnoid haemorrhage.
There are a number of cases in the literature were sub-arachnoid hemorrhage has been associated with significant ST changes:
- Van der Velden LBJ,Otterspoor LC,Schultze Kool LJ,Biessels GJ, Verheugt FWA. Acute myocardial infarction complicating subarachnoid haemorrhage. Neth Heart J. 2009 Aug; 17(7-8): 284–287.
- I Beydilli, I Korkmaz, F Yilmaz,Eren, C Kavalci, M Yilmaz. Subarachnoid Hemorrhage Mimicking Myocardial Infarction. The Internet Journal of Emergency Medicine. 2012 Volume 7 Number 2.
- S Chatterjeec.ECG Changes in Subarachnoid Haemorrhage: A Synopsis.Neth Heart J. 2011 Jan; 19(1): 31–34.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.