Wednesday, 21 February 2018

ECG of the Week - 19th February 2018 - Interpretation

The following ECG is from a 57 yr old male who presented to the Emergency Department complaining of chest pain for 1 hour. He is an ex-smoker and has a history of hypertension and hypercholesterolaemia.

Click to enlarge

  • Mean ventricular rate 84 bpm
  • Irregular
  • Absent p waves
  • Normal
  • QRS - Normal (100ms)
  • ST Elevation leads II (1-2mm) III (3mm) aVF (2mm)
  • ST Depression leads I, aVL, V2-6

  • T wave inversion leads I, V3-6
  • Biphasic T wave leads aVL, V2
  • R/S ratio V2 >1
  • Voltage criteria for LVH


  • Infero-posterior STEMI
  • Atrial fibrillation

What happened ?

The patient was transferred for urgent angiography which showed:

  • Left main - Normal
  • LAD - Normal
  • Left circumflex - 70% Mid-Cx lesion --> stented
  • RCA - Normal

Post angiography echo showed severe aortic stenosis, dilated left atrium, increased LV wall thickness / mass and hypokinesis to to left ventricle.

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.