ECG of the Week - 20th June 2016 - Interpretation

The following ECG is from a 61 yr old male who presented with a 4/7 history of central chest pain. Past medical history of hypertension, diabetes and smoking.

Click to enlarge

Rate:

• 54 bpm

Rhythm:

• Regular
• 2:1 AV block

Axis:

• Normal

Intervals:

• QRS - Normal (100ms)
• QT - 320 ms

Segments:

• ST Elevation leads II (1mm), III (2mm), aVF (1mm)
• ST Depression leads I, aVL, V 1-5

Additional:

• Prominent T wave leads V 2-3

Interpretation:

• Inferior STEMI
• 2:1 AV Block

What happened ?

The patient was taken for urgent angiography, which showed:

• Right dominant system
• Left main: Normal
• LAD: Mild mid-stenosis
• Cx: Normal
• RCA: 70% Proximal stenosis, 100% mid-stenosis, 70% distal stenosis

3 x Drug-eluting stents were place in across the RCA lesions. The patient made an uneventful recovery following angiography and reverted to sinus rhythm 48 hours post stenting.

References / Further Reading

Life in the Fast Lane

• Inferior STEMI
• Posterior STEMI
• Right ventricular infarction
• Fixed ratio AV block 2:1

Textbook

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