ECG of the Week - 5th September 2016 - Interpretation

The following ECG is from a 60 yr old female who presented complaining of central chest pain. Background of hypertension and a prior smoking history.

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Rate: 

• 84 bpm

Rhythm:

• Regular 
• Sinus rhythm 

Axis:

• Normal

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (90ms)
• QT - 400ms (QTc Bazette 435 ms)

Segments:

• ST elevation leads aVL (<1mm) I (2nd & 3rd complexes <1mm)
• ST depression leads II, III, aVF

 Additional:

• Up-sloping ST segment V6
• T wave inversion leads III, aVR, V1

Interpretation:

• High lateral changes suspicious for ACS

What happened ?

Following discussion with the cardiology team the patient was transferred for primary angioplasty given on-going chest pain and progressive ECG features.

Coronary angiogram showed:

• LM - Normal
• Cx - Dominant with irregularities
• LAD & RCA - irregularities
• LV gram - Apical Hypokinesis

Subsequent echo showed:

• Normal LV size and thickness.
• Hypokinesis of mid to apical anterolateral, anterior and inferior lateral regions with normal systolic function.

Given echo and angiogram findings the patient was diagnosed with Takotsubo cardiomyopathy. She was commenced on beta-blocker therapy and discharge with out-patient follow-up.

References / Further Reading

Life in the Fast Lane

• Takotsubo cardiomyopathy

Textbook

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