ECG of the Week - 11th July 2016 - Interpretation

The following ECG is from a 38 yr old male who presented complaining of chest pain. Current smoker but nil medical or family history.

Click to enlarge

Rate:

• 66

Rhythm:

• Regular
• Sinus Rhythm

Axis:

• Normal (-33 deg)

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (100ms)
• QT - 380ms (QTc Bazette 380-400 ms)

Segments:

• Subtle ST depression leads V4-6

Additional:

• Deep T wave inversion lead III
• Biphasic T wave lead aVF
• Prominent T waves leads I, aVL (of equal or greater height than QRS)

Interpretation:

• Very suspicous ECG for ACS

What happened ?

The patient had serial ECG's which showed dynamic T wave changes in the inferior leads and T wave amplitude antero-laterally. Serial troponins were positive.
The patient underwent angiography which showed:

• LMCA: Minor irregularities
• LAD: Mid 99% single discrete lesion
• Ostial 1st Diagonal: 90% single discrete lesion
• CX: Irregularities
• RCA: Irregularities

A stent was inserted to the LAD lesion and the ostial lesion was treated with balloon angioplasty. Echo showed normal systolic and valvular function.
The patient was commenced on dual anti-platelet therapy (DAPT), statin, ACE and beta-blocker therapy.

References / Further Reading

Life in the Fast Lane

• T Wave

Textbook

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