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.

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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

• High lateral STEMI

Textbook

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