Wednesday, 23 March 2016

ECG of the Week - 21st March 2016 - Interpretation

The following ECG's are from a 58 yr old male who presented with chest pain onset 30 mins prior. He had an episode of exertional chest pain the day prior and is a smoker. The ECG's were performed 10 minutes apart.




Click to enlarge
Rate:
  • 54 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~180ms)
  • QRS - Normal (100ms)
  • QT - 440ms
Segments:

  • ST Elevation leads aVR, V1 (1-1.5mm), V2 (<1mm)
  • ST Depression leads I, II, V4-6


Additional:

  • Marked hyperacute T waves in leads V2-4
  • Some ST segment analysis is difficult due to baseline artifact
  • T wave inversion lead III


Interpretation:




Click to enlarge

Rate:
  • 72 bpm
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (80ms)
  • QT - 400ms
Segments:
  • ST Elevation leads aVR, V1-4, aVL
  • ST Depression III, aVF, V5-6

Interpretation:

  • Progressive ST segment change from the 1st ECG with clear STEMI pattern


What happened ?

The patient went for urgent angiography which showed:

  • LM: Normal
  • LAD: Proximal 80% Mid 70% stenosis
  • LCx: moderate diffuse disease
  • RCA (Dominant): Mild 50%, Distal 70% PLV 80%
  • LV: Anterior hypokinesia with mild-mod LV dysfunction

The LAD lesion under DES PCI and the patient returned to hospital 2 months later for an elective staged PCI to the RCA.

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.