Wednesday, 29 March 2017

ECG of the Week - 27th March 2017 - Interpretation

This ECG is from a 63yr old male who presented with chest pain. He has a 1 month history of exertional chest pain and continuous chest pain for the last 3 hours. He is a hypertensive, ex-smoker with a positive cardiac family history.

Click to enlarge
Rate:
  • 72 bpm
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (100ms)
  • QT - 360ms
Segments:

  • ST Elevation leads aVR (1mm) aVL (1mm) V1 (1mm)
  • ST Depression leads II, III, aVF, V4-6

Additional:

  • Prominent  U-wave in antero-septal leads
  • T wave inversion infero-lateral leads
    • Down-up morphology may be due to prominent U waves

Interpretation:

  • Acute ACS
    • Patient with history suspicious of ACS
    • ST / T changes indicative of ACS


What happened ?

The patient was taken for urgent angiography which showed:
  • Right dominant system
  • LM: 50% distal
  • LAD: 90% proximal
  • Cx: 90% mid
  • RCA: 99% distal RCA with 80% ostial - TIMI 3 flow & pain-free patient
  • RCA: Supplying large PDA and 3 PLV branches
  • LH Cath: Inferior akinesis with mild LV impairment
The patient was then transferred to tertiary centre for urgent CABG given severe multi-vessel disease.

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.