ECG of the Week - 1st February 2016 - Interpretation

The following ECG is from a 60yr old male who had an out-of-hospital cardiac arrest. Return of spontaneous circulation was attained pre-hospital.

Click to enlarge

Rate:

• 120 bpm

Rhythm:

• Regularly irregular
• Bigeminy 
• Alternating sinus complex and PVC

Axis:

• Sinus complex - normal axis
• PVC - extreme axis

Intervals- Sinus Complex:

• PR - Normal (~200ms)
• QRS - Normal (100ms)
• QT - 480ms

Intervals- PVC's:

• QRS - Prolonged (120ms)

Segments - Sinus complexes:

• ST Elevation leads V2 (2mm) V3 (3mm) V4 (2mm) V5 (2mm) V6 (1mm)

Additional:

• T inversion lead aVL
• Hyperacute T waves leads V2-4
• Excessive discordant ST elevation in the PVC's leads V2-6 - see edited ECG'sbelow

Interpretation:

• Antero-lateral STEMI
• Bigeminy

What happened ?

The patient was taken for urgent angiography and PCI and has a mid-LAD lesion stented.

Whilst the key features on this ECG and reasonably apparent the presence of frequent PVC can distract the eye and male interpretation difficult. I've edits the ECG below to show only the sinus complexes.

ECG with only sinus complexes shown

The ECG below is edited to only show the PVC's as they exhibit excessive discordant ST elevation due to concurrent infarction.

ECG with only PVC's shown

References / Further Reading

Life in the Fast Lane

• Anterior STEMI
• Lateral STEMI
• PVC

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.