ECG of the Week: ECG of the Week - 28th March 2016

Wednesday, 30 March 2016

ECG of the Week - 28th March 2016 - Interpretation

The following ECG series is froma 58 year old male who was referred by his GP following 14 hours of central chest pain. His past medical history included hypertension, hypercholesterolemia, and smoking.

ECG at GP's

Click to enlarge

Rate:

78 bpm

Rhythm:

Regular
Sinus rhythm

Axis:

Intervals:

PR - Normal (~200ms)
QRS - Normal (100ms)
QT - 400ms

Segments:

ST Elevation leads III, aVF (~1mm)

? Inferio Q wave ? rS wave

ST Depression aVL

Interpretation:

Delayed Inferior STEMI

ECG on arrival ED

Performed ~ 60 minutes after ECG above

Click to enlarge

Rate:

75 bpm

Rhythm:

Sinus Arrhythmia

Axis:

Normal

Intervals:

PR - Normal (~200ms)
QRS - Normal (100ms)
QT - 400ms (QTc Bazette 380-400 ms)

Segments:

Inferior ST segment elevation improved compared with previous ECG

Additional:

Complex #10 - fusion / PJC

Interpretation:

Dynamic ECG changes in a patient with ongoing chest pain

ECG performed ~60 minutes after initial ED ECG

Click to enlarge

Rate:

Rhythm:

Regular
Nil p waves

Axis:

Intervals:

QRS - Prolonged (100ms)

Segments:

Discordant ST segment change

Additional:

Not typical LBBB / RBBB Morphology

Interpretation:

Accelerated Idioventricular Rhythm

What happened ?

Following discussion with cardiology team due to dynamic ECG changes and ongoing chest pain he was taken for urgent Coronary Angiogram, which showed:

LMCA- Irregularities
Prox LAD- Irregularities
Mid/distal LAD- 70-80%, multiple discrete lesions
Ostial 1st Diag- 99%, single discrete lesion, small vessel
Cx- Irregularities
Prox RCA- 90%, single discrete lesion
Mid RCA- 100%, unknown length stenosis, heavy thrombus burden

6 stents were inserted into the RCA extending into the PLA. The patient's stay was complicated by a lower GI bleed which settled without invasive treatment and he was discharge with out-patient cardiology follow-up on dual anti-platelet therapy (DAPT).