ECG of the Week: ECG of the Week - 8th April 2013

Wednesday, 10 April 2013

ECG of the Week - 8th April 2013 - Interpretation

This ECG is from a 52 year old male presenting with chest pain.

Click to enlarge

Rate:

~108 bpm

Rhythm:

Irregularly irregular
Sinus rhythm
Frequent PVCs

Unifocal
Single & Couplets
Evidence of compensatory pauses

Axis:

Sinus Complexes - Normal (+70 deg)
PVC - LAD

Intervals:

PR - Normal (~180ms)
QRS - Sinus Complexes - Normal (100ms)
QRS - PVCs - Prolonged (120-140ms)
QT - 320ms (QTc Bazette ~ 420 ms)

Segments:

ST Elevation Leads

II (1mm),III (2mm), aVF (3mm)
? V6 (0.5mm) - single complex with uneven baseline

ST Depression Leads aVL, V1-3

Additional:

T wave inversion aVR, aVL, V1-3
P wave inversion Leads aVR, V1-2
R wave V1-3
PVCs - Discordant T wave & ST segment changes

Interpretation:

Acute STEMI

Inferior with ? postero-lateral involvement

This is an older case from my ECG collection but the clinicians looking after this patient were concerned about possible right ventricular involvement as an ECG with partial right precordial leads, V3-5R, was performed which is below:

Click to enlarge

There is no evidence for ST elevation in the right sided leads making RV involvement very unlikely. I don't know if posterior leads were performed, I don't have a posterior lead ECG from this case.

What happened ?

This is an older case from early 2012 but I managed to get some information on the ultimate outcome.

The ECG features were immediately recognized and STEMI protocol was activated.
The patient underwent an uneventful transfer for PCI which revealed a 100% occlusion of the proximal RCA which was stented.

The patient was commenced on aspirin, prasugrel, statin, ACE, and beta-blocker therapy.
He was discharged after a 3 day in-patient stay.

References / Further Reading

Life in the Fast Lane