Wednesday, 27 December 2017

ECG of the Week - 25th December 2017 - Interpretation

The following ECG's are from a 89 yr old female who presented with chest pain. She has a history of 2nd degree AV block with PPM in-situ.

ECG on arrival
Click to enlarge
Key features:
  • Rate 60 bpm
  • Regular V-paced rhythm
  • LBBB Morphology
  • Discordant ST / T wave changes
  • T waves in leads V2-4 appear prominent
  • Concordant ST elevation in lead I with a positive QRS
    • Subtle and easy to miss

ECG 60 mins later
Further chest pain
Click to enlarge 
Key features:

  • Rate 60 bpm
  • Regular V-paced rhythm
  • LBBB Morphology
  • Significant progression of ST and T wave changes
    • Massive ST elevation (>5mm) in leads V2-4 also proportionately >25% of QRS depth
    • Discordant ST elevation in leads II, III, aVF, V5
      • Significantly more pronounced than on previous ECG
    • Concordant ST elevation in leads I and V6


  • Sgarbossa positive ECG's
    • Dynamic and progressive ST segment changes
    • Underlying V-paced rhythm with LBBB morphology

What happened ?

The patient was discussed with the cardiology team and taken for angiography.
This showed an acute mid LAD occlusion treated with a bare metal stent. Post angiography echo showed moderate systolic and diastolic dysfunction. She was discharged following a 2 day in-patient stay.

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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