Wednesday, 8 March 2017

ECG of the Week - 6th March 2017 - Interpretation

The following ECG's are from a 62 yr old male. He has a known 60% LAD stenosis, hypertension and hypercholesterolaemia. He presented to the Emergency Department following 3 episodes of chest pain that day, each resolved with GTN. The two ECG's were recorded 10 minutes apart and the second ECG was performed during an episode of chest pain.

 
Pain free ECG
Click to enlarge
Key features
  • Rate 96 bpm
  • Regular sinus rhythm
  • Normal axis
  • ST depression leads I, II, III, aVF, V3-6
  • ST Elevation leads aVR V1 ~1mm

10 Minutes later
Episode of chest pain
Click to enlarge
Key features
  • Rate 102 bpm
  • Regular sinus rhythm
  • Massive ST elevation V3-4
  • ST Elevation I, II, V1, V5
  • Hyperacute T waves leads II, III, aVF
  • T wave inversion lead aVL
 
What happened ?
 The patient was transferred for urgent PCI complicated by a period of VF arrest.Angiogram showed:
  • Left main normal
  • LAD Severe proximal-mid stenosis
  • LCx dominant mild disease
  • RCA mild disease
The culprit LAD lesion was stented and post intervention echo showed normal LV size and function. 
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.