ECG of the Week - 18th November 2013 - Interpretation

This week's ECG is from a 65 yr old male who presents with chest pain.
Intermittent exertional chest pain over the preceding week .
Continuous chest pain for the last hour with dysponea and diaphoresis.
Past history of hypertension. Non smoker with no family history.
Check out the comments on our original post here.

Click to enlarge

Rate:

• 78

Rhythm:

• Regular
• Sinus rhythm

Axis:

• LAD (-35 deg)

Intervals:

• PR - Normal (~140ms)
• QRS - Normal (100ms)
• QT - 380ms (QTc Bazette ~ 430 ms)

Segments:

• ST Elevation leads aVR (1mm) V1 (2mm), V2 (4mm), V3 (3mm), V4 (2mm)
• ST Depression leads I, II, V6

Additional:

• Small q wave leads aVL, V2, V3
• Prominent 'hyperacute' Twaves leads V1-4

Interpretation:

• Acute Anterior STEMI

What Happened ?

The patient was transferred for immediate PCI which showed:

• Mid-LAD 100% Occlusion --> Stented
• All other vessels normal
• Apical akinesis on ventriculogram

The patient was discharged following a 3 day in-patient stay.

References / Further Reading

Life in the Fast Lane

• Anterior STEMI here

Textbook

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