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- 72
- Regular
- Sinus rhythm
- Normal
- PR - Normal (~180ms)
- QRS - Normal (80ms)
- QT - 320ms (QTc Bazette 380-400 ms)
- ST Elevation leads I (0.5mm) aVL (0.5mm) V1 (2mm) V2 (3mm) V3 (2mm)
- Concave morphology
- ST Depression III, aVF, V5-6
Additional:
- T wave inversion leads III, V4-6
- Broad P wave in inferior leads with biphasic P wave in V1
- Left atrial abnormality (LAA)
- Voltage criteria LVH
- aVR ~14mm
- R wave V5 + S wave V1 ~35-36mm
- LV 'Strain' features - lateral ST depression and T wave inversion
Interpretation:
- LVH with secondary ST / T wave changes
- V3 suspicious for ACS given relative height of ST elevation in relation to R-S magnitude
- Seen links below
The patient had attended hospital ~2 yrs prior with chest pain and a similar ECG. At that time the patient was taken for urgent PCI which showed no artery disease and normal LV function. Biomarkers were negative with an echo showing mild-moderate LVH.
This presentation's ECG showed no new changes, when compared with previous, and serial biomarkers were negative.
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:
- http://www.ecg-quiz.com/guidelines/stemi-vs-hypertrophy/
- http://doccottlesdesk.blogspot.com.au/2012/07/distinguishing-stemi-from-lvh-on-ecg.html
- http://hqmeded-ecg.blogspot.com.au/2014/01/st-elevation-and-positive-troponin-is.html
- http://hqmeded-ecg.blogspot.com.au/2013/12/hyperacute-t-waves-anterior-stemi-no.html
- http://hqmeded-ecg.blogspot.com.au/2011/01/not-all-cases-with-reciprocal-st.html
- http://hqmeded-ecg.blogspot.com.au/2011/04/cath-lab-activated-what-do-you-think.html
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.
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