Sunday, 12 July 2015

ECG of the Week - 6th July 2015 - Interpretation

The following ECG is from a 65 year old male who was brought to the Emergency Department following an out-of-hospital cardiac arrest. ROSC was achieved pre-hospital following an episode of VT. ON arrival GCS 3, intubated with sats 98%, BP 75 systolic.
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Rate:
  • ~84 bpm
Rhythm:
  • Regular
Axis:
  • RAD
Intervals:
  • PR - Prolonged(~220ms)
  • QRS - Normal (80-100ms)
  • QT - 400ms (QTc Bazette 470-480 ms)
Segments:

  • ST Elevation leads II, III, aVF, V4, V6
    • Unusual ST morphology in inferior leads
  • ST depression lead aVL, V1-3

Additional:

  • Note complete lead inversion leads I, aVL - negative P/QRS/T
Interpretation:

  • STEMI
  • 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:




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.