Wednesday, 9 November 2016

ECG of the Week - 7th November 2016 - Interpretation

This ECG is from a 72 yr old female who presented with 30 minutes of central chest tightness radiating to the back. She has a history of hypertension.




Click to enlarge
Rate:
  • 78 bpm
Rhythm:
  • Sinus arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Normal (~180ms)
  • QRS - Normal (80-100ms)
  • QT - 380ms (QTc Bazette 435 ms)
Segments:

  • ST Elevation leads I & aVL (~1mm)
  • ST Depression leads II, III, aVF, V4-5

Additional:
  • Prominent T wave lead V2
Interpretation:
  • High lateral STEMI
What happened ?

Patient was taken for urgent angiography which showed:

  • Left main: Irregularity
  • LAD: Diffuse disease 60% mid
  • D1: 90% Mid
  • LCx: 90% Proximal 70% Mid - PCI to LCx
  • OM3: 70% Ostial
  • RCA: Dominant 70% Ostial long 40-50% Mid

Post angio echo showed normal LV function and size with apico-lateral hypokinesis.

The patient made an uneventful post procedural recovery and will likely need further PCI to RCA & LAD.

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.