ECG of the Week - 16th November 2015 - Interpretation

The following ECG is from a 67 yr old with chest pain for the last hour.

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Rate:

• Atrial rate 78 bpm
• Ventricular rate 36 bpm

Rhythm:

• Regular escape rhythm
• Complete heart block

Axis:

• Normal

Intervals:

• QRS - Normal (100ms)
• QT - 480ms

Segments:

• ST Elevation leads II (2mm), III (4mm), aVF (3mm), V4-6 (~1mm)
• ST Depression leads I, aVL, V1-2

Additional:

• Small initial R wave in leads V1-3

Interpretation:

• Inferior STEMI
• Flat ST depression V2-3 likely posterior involvement
• RV Involvement difficult to judge due to ST depression in leads V2-3 and likely posterior involvement

What happened ?

I unfortunately don't have any clinical conclusion for this case but it highlights a number of the features to consider in inferior STEMI i.e. associated AV block, potential for RV involvement and features of posterior and lateral extension

References / Further Reading

Life in the Fast Lane

• Inferior STEMI
• Right Ventricular Infarction
• Lateral STEMI
• Complete heart block
• Posterior STEMI

Textbook

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