Saturday, 25 June 2016

ECG of the Week - 20th June 2016 - Interpretation

The following ECG is from a 61 yr old male who presented with a 4/7 history of central chest pain. Past medical history of hypertension, diabetes and smoking.



Click to enlarge
Rate:
  • 54 bpm
Rhythm:
  • Regular
  • 2:1 AV block
Axis:
  • Normal
Intervals:
  • QRS - Normal (100ms)
  • QT - 320 ms
Segments:
  • ST Elevation leads II (1mm), III (2mm), aVF (1mm)
  • ST Depression leads I, aVL, V 1-5
Additional:
  • Prominent T wave leads V 2-3
Interpretation:

  • Inferior STEMI
  • 2:1 AV Block

What happened ?

The patient was taken for urgent angiography, which showed:
  • Right dominant system
  • Left main: Normal
  • LAD: Mild mid-stenosis
  • Cx: Normal
  • RCA: 70% Proximal stenosis, 100% mid-stenosis, 70% distal stenosis

3 x Drug-eluting stents were place in across the RCA lesions. The patient made an uneventful recovery following angiography and reverted to sinus rhythm 48 hours post stenting.

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.