ECG of the Week - 3rd September 2012 - Interpretation

This ECG is from a 64 year old with chest pain.

Click to enlarge

 
Rate:

• 51

Rhythm:

• Regular Sinus Rhythm

 Axis:

• Normal (+30 deg)

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (~80ms)
• QT - 460ms (QTc Bazette ~ 420 ms)

Segments:

• ST Depression V1-4
• ST Elevation ~1mm V6
• T Inversion V1, aVR

 Additional:

• Inverted P waves I, II, III, aVF, V5-6
• Positive P wave aVR
• U waves V2-5

Interpretation:

• ST Depression in Antero-septal leads
• ST Elevation in lateral precordial lead
• Need to consider Posterior Infarction given above findings
• Ectopic Atrial Rhythm

ECG with Posterior Leads (V7-9 replacing V4-6) was performed and is shown below.

Click to enlarge

• ST Elevation in Posterior Leads V7-9 (~1mm V7-8)
• Note P wave abnormalities in initial ECG have resolved

References / Further Reading
 

Life in the Fast Lane

• Posterior STEMI here

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.