ECG of the Week - 8th September 2014 - Interpretation

This week's ECG is from a 75 yr old female. Past medical history of GORD. She presented complaining of 3 hours of epigastric pain with severe nausea and multiple episodes of vomiting.

Click to enlarge

Rate:

• 66 bpm

Rhythm:

• Regular
• Sinus rhythm
• Baseline artifact makes P waves difficult to see but best seen in leads V1-3

Axis:

• Normal

Intervals:

• PR - Prolonged (280ms)
• QRS - Normal (80-100ms)
• QT - 380ms (QTc Bazette 400 ms)

Segments:

• ST Elevation leads III, aVF (<1mm)
• Flat ST depression V1-3

Additional:

• T wave inversion leads I, aVL, aVR, V1-3
• Prominent T waves leads III, aVF, V6
• Prominent R wave lead V2

Interpretation:

• Infero-postero-lateral MI

What happened ?

The patient had posterior leads performed, ECG below:

Posterior leads show clear ST elevation and the eagle-eye'd among you will notice that leads V1-3 are clearly different from the first ECG.
Our local lead set-up means V1-3 on this ECG are certainly leads V4-6 but haven't been labelled as such. 

The patient was transferred for urgent PCI and a lesion was stented. 

Unfortunately the hospital discharge summary doesn't state where the culprit lesion was !!



References / Further Reading

Life in the Fast Lane

• Posterior STEMI

Textbook

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