Rate: sinus tachycardia @ ~105 Regularity: irregular, frequent PVCs interrupting P-waves: sinus PRi: 160ms, associated 1:1 QRSd: 110ms Rhythm: sinus tachycardia with frequent short-coupled PVCs and couplet PVCs. Axis: normal QTi/QTc: normal ST/T-waves: inferiolateral MI w/ reciprocal changes (or posterior extension). Could be RCA or LCX, I'm leaning towards RCA as III has just a bit more elevation than II.
DDx: inferior MI w/ likely posterolateral extension leading to R-on-T PVC's placing our patient at a high risk for sustained VT or degeneration into VF. Cath lab would be a solid option, with lytics followed by rescue PCI if E2B/D2B would exceed 90 minute guidelines.
Rate- difficult to determine but approximately 96 bpm Some sinus beats and others ectopic in origin Normal axis PR intervals-normal when present QRS- normal duration when preceded by a p wave. Widened 0.24 sec when ectopic in origin QT normal duration ST elevation of 1mm in leads II, III and aVF ST depression in aVL or 2mm Marked T wave inversion in leads V1,V2 and V3 Negative p waves in V1
Interpretation Myocardial infarction with ST elevation in the inferior leads with some reciprocal changes in the anterior leads. Ventricular origin ectopic beats in singles and couplets, different focuses of ventricular ectopics due to the different morphologies of the ectopic beats.
In the setting of chest pain then this would warrant urgent cardiac catherisation
Description ======== Rate: approximately 100bpm Rhythm: sinus, regularly irregular intervened by wide complex QRS, resembling non-sustained VTs Axis: normal
P: normal height and morphology, 1:1 P:QRS ratio. PR interval 160ms QRS: <100ms, narrow complexes on rhythm strip, however frequently intervened by broad complexes QRS, non-sustained VTs. No fusion/capture beat present. No AV dissociation present ST: markedly elevated in inferior leads (2,3,AVF). Lead 3 not more than lead 2. Reciprocal ST depression in anterior precordial leads. Presence of AVL ST-depression highly suggestive of posterior extension. Will need R sided ECG to confirm QT: roughly 400ms uncorrected. No hyperacute Ts present
Summary ====== Highly abnormal 12-lead ECG indicating unstable inferior STEMI, with reciprocal changes on AVL and anterior precordial suggestive of posterior extension. Culprit lesion likely RCA/LCx. Emergent management needed in view of rhythm instability with intermittent progression to NSVTs. Definitive management would be PTCA If deteriorate into sustained VT/VF, manage accordingly to ACLS guidelines
Agree with above. Christopher is 100% on the mark - Acute Infero-postero-lat MI (probable prox RCA occlusion) - frequent PVCs/couplets. Of note - inferior Q waves have already formed. Acute cath lab activation was hopefully done as soon as this ECG was seen ...
Asia represent!!!
ReplyDeleteWhoa.. much badness.
Inf MI with post extension and non sustained VT.
Get pads on pt and pt into an angio suite!
Agreed with the above :)
ReplyDeleteIn detail:
Rate: sinus tachycardia @ ~105
Regularity: irregular, frequent PVCs interrupting
P-waves: sinus
PRi: 160ms, associated 1:1
QRSd: 110ms
Rhythm: sinus tachycardia with frequent short-coupled PVCs and couplet PVCs.
Axis: normal
QTi/QTc: normal
ST/T-waves: inferiolateral MI w/ reciprocal changes (or posterior extension). Could be RCA or LCX, I'm leaning towards RCA as III has just a bit more elevation than II.
DDx: inferior MI w/ likely posterolateral extension leading to R-on-T PVC's placing our patient at a high risk for sustained VT or degeneration into VF. Cath lab would be a solid option, with lytics followed by rescue PCI if E2B/D2B would exceed 90 minute guidelines.
Here is my attempt:
ReplyDeleteRate- difficult to determine but approximately 96 bpm
Some sinus beats and others ectopic in origin
Normal axis
PR intervals-normal when present
QRS- normal duration when preceded by a p wave.
Widened 0.24 sec when ectopic in origin
QT normal duration
ST elevation of 1mm in leads II, III and aVF
ST depression in aVL or 2mm
Marked T wave inversion in leads V1,V2 and V3
Negative p waves in V1
Interpretation
Myocardial infarction with ST elevation in the inferior leads with some reciprocal changes in the anterior leads.
Ventricular origin ectopic beats in singles and couplets, different focuses of ventricular ectopics due to the different morphologies of the ectopic beats.
In the setting of chest pain then this would warrant urgent cardiac catherisation
ECG of 52 yo man with chest pain
ReplyDeleteDescription
========
Rate: approximately 100bpm
Rhythm: sinus, regularly irregular intervened by wide complex QRS, resembling non-sustained VTs
Axis: normal
P: normal height and morphology, 1:1 P:QRS ratio. PR interval 160ms
QRS: <100ms, narrow complexes on rhythm strip, however frequently intervened by broad complexes QRS, non-sustained VTs. No fusion/capture beat present. No AV dissociation present
ST: markedly elevated in inferior leads (2,3,AVF). Lead 3 not more than lead 2. Reciprocal ST depression in anterior precordial leads. Presence of AVL ST-depression highly suggestive of posterior extension. Will need R sided ECG to confirm
QT: roughly 400ms uncorrected. No hyperacute Ts present
Summary
======
Highly abnormal 12-lead ECG indicating unstable inferior STEMI, with reciprocal changes on AVL and anterior precordial suggestive of posterior extension. Culprit lesion likely RCA/LCx.
Emergent management needed in view of rhythm instability with intermittent progression to NSVTs. Definitive management would be PTCA
If deteriorate into sustained VT/VF, manage accordingly to ACLS guidelines
Agree with above. Christopher is 100% on the mark - Acute Infero-postero-lat MI (probable prox RCA occlusion) - frequent PVCs/couplets. Of note - inferior Q waves have already formed. Acute cath lab activation was hopefully done as soon as this ECG was seen ...
ReplyDelete