ECG of the Week - 8th February 2016 - Interpretation

The following ECG is from a 56 yr old female who presented with 3 hours of typical cardiac chest pain. The pain onset coincided with an episode of emotional distress.

Click to enlarge

Rate:

• 78 bpm

Rhythm:

• Sinus rhythm
• Single PAC seen in leads V1-3

Axis:

• Normal

Intervals:

• PR - Normal (~140ms)
• QRS - Normal (100ms)
• QT - 400ms (QTc Bazette 455ms)

Segments:

• ST Elevation leads aVR, V1, V2 - all <1mm
• ST Depression leads II, III, aVF, V3-6

Additional:

• Prominent T waves leads I, II, aVL, V2-3

Interpretation:

• ST changes suspicious for ACS
• The patient had ongoing chest pain and was taken for urgent angiography

What happened ?

The angiogram showed no coronary vessel disease but Takotsubo pattern cardiomyopathy.

Check out some great cases from Dr Smith's ECG blog on Takotsubo here:

• COPD Exacerbation precipitating Takotsubo - great echo images
• Infarction mimicking Takotsubo !!!

Other resources

• eMedicine - Takotsubo Cardiomyopathy
• Life in the Fast Lane - Tako-tsubo Cardiomyopathy

References / Further Reading

Life in the Fast Lane

• Tako-tsubo Cardiomyopathy

Textbook

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