Friday, 20 November 2015

ECG of the Week - 16th November 2015 - Interpretation

The following ECG is from a 67 yr old with chest pain for the last hour.


Click to enalrge

Rate:

  • Atrial rate 78 bpm
  • Ventricular rate 36 bpm
Rhythm:
  • Regular escape rhythm
  • Complete heart block
Axis:
  • Normal
Intervals:
  • QRS - Normal (100ms)
  • QT - 480ms
Segments:
  • ST Elevation leads II (2mm), III (4mm), aVF (3mm), V4-6 (~1mm)
  • ST Depression leads I, aVL, V1-2
Additional:
  • Small initial R wave in leads V1-3

Interpretation:
  • Inferior STEMI
  • Flat ST depression V2-3 likely posterior involvement
  • RV Involvement difficult to judge due to ST depression in leads V2-3 and likely posterior involvement
What happened ?

I unfortunately don't have any clinical conclusion for this case but it highlights a number of the features to consider in inferior STEMI i.e. associated AV block, potential for RV involvement and features of posterior and lateral extension

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.