ECG of the Week - 7th January 2013 - Interpretation

This is one of the older ECG's I have in my collection, and it didn't come with any clinical information, sorry.

Click to enlarge

Rate:

• 78

Rhythm:

• Regular
• Sinus Rhythm

Axis:

• Normal (+45 deg)

Intervals:

• PR - Normal (~200ms)
• QRS - Normal (80-100ms)
• QT - 360ms (QTc Bazette ~ 400 ms)

Segments:

• Slight ST Elevation Lead II
• ST Elevation V2-3 (~1mm)
• ST Elevation V4 (Variable magnitude with wandering baseline)

Additional:

• T Wave Inversion Leads I, aVL
• T Flattening V6
• Positive T wave V1
• Biphasic T waves V2-V4

 

Interpretation:

• Type 2 Wellen's Pattern
• High lateral ischaemic changes
• Anterior ST elevation

• Patient requires urgent cardiology consultation given high likelihood of critical LAD lesion., and risk of anterior wall AMI.
• Read more about Wellen's from these resources below.

References / Further Reading

 

Life in the Fast Lane

• Wellen's Syndrome here

Dr Smith's ECG Blog

• Is this Wellen's Syndrome ?
• Wellen's Syndrome No Culprit
• All Wellen's Labelled Posts

Article

• Rhinehardt J, Brady WJ, Perron AD, Mattu A. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med. 2002 Nov;20(7):638-43. PMID: 12442245 Full text here
• Mead NE, O'Keefe KP. Wellen's syndrome: An ominous EKG pattern. J Emerg Trauma Shock. 2009 Sep-Dec; 2(3): 206–208.  Full text here.

Textbook

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