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- Mean ventricular rate 102 bpm
- No P waves visible
- Single PVC (Complex #5)
- QRS - Normal (80ms)
- QT - 400ms (QTc Bazette 380-400 ms)
- ST Elevation leads aVR and V1
- ST Depression leads I, II, III, aVF, V4-6
- Atrial Fibrillation with tachycardia
- Things to establish
- Is this new or chronic ?
- Is it primary or secondary ?
- What treatment is the patient on ?
- ST Segment changes
- Broad differentials including:
- Electrolyte abnormality
- Drug effect - digoxin
Many people will say this ECG is consistent with LMCA occlusion but we must remember the pattern of STE in aVR and diffuse ST depression is most often seen in demand ischaemia.
In this patient's case she had established AF treated with digoxin. Serial troponins showed a slight rise secondary to her occult GI bleed !
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.