Wednesday, 18 January 2017

ECG of the Week - 16th January 2017 - Interpretation

These ECG's are from a 62yr old male who was under out-patient investigation following an episode of chest pain. He was referred to the Emergency Department after completing an exercise stress test in which he became symptomatic with chest pain. On arrival to the Emergency Department he was pain free.

ECG during EST
Chest pain
Click to enlarge
Key features

  • Tachycardia rate ~144 bpm
  • Sinus rhythm
    • P waves best seen in lead II rhythm
  • ST elevation leads aVR (3mm) aVL (1-2mm) V1 (3mm) V2 (3mm) 
  • ST depression leads II, III, aVF, V3-6

Strongly positive EST with acute symptomatic ST elevation. The EST was ceased and following a brief period of rest the patient's ECG normalised and symptoms resolved. He was referred, via the Emergency Department, for urgent cardiology review / intervention.

ECG on arrival to ED
Pain free
Click to enlarge
Key features

  • Sinus rhythm, rate ~60bpm
  • Resolution of ST segment changes seen during EST
  • Biphasic T wave lead V2 - Type A Wellen's pattern
  • T wave inversion aVL
  • Positive T wave V1
  • U waves best seen in anterior and inferior leads
What happened ?

The patient was admitted following initial treatment with dual anti-platelet therapy and heparinisation. He underwent urgent angiogram which showed:

  • Left main 80% ostial lesion
  • LAD 80% mid lesion
  • Cx irregularities
  • RCA dominant irregularities
  • Normal LV function
Whilst awaiting urgent CABG the patient developed an acute STEMI which was treated with PCI to ostial-LAD and mid-LAD lesions

A bit about Exercise Stress Testing

Here are some nice articles that cover EST indications / limitiation / result interpretation:

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.

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