ECG of the Week - 24th October 2016 - Interpretation

The following ECG is from a 62 yr old male who presented with 90 minutes of central chest pain.

Click to enlarge

Rate:

• Mean ventricular rate 90 bpm

Rhythm:

• Bigeminy
• Regularly irregular
• Sinus complex followed by premature complex fixed ratio

Sinus Complexes

The presence of bigeminy means it's easy to get confused and distracted.
The ECG below has the premature complexes removed.

Click to enlarge

Axis:

• Normal

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (100ms)

Segments:

• ST Elevation leads II (1mm), III (2mm), aVF (2mm), V6 (1mm)
• ST depression leads V1-4, aVL

Additional:

• rSr' pattern V1
• Hyperacute T wave lead V5
• T inversion leads aVL, V1-2

Premature Complexes

The premature complexes also have some interesting features.

Click to enlarge

Key features

• LAD
• QRS - Prolonged (120ms)
• Excessive discordant ST elevation in leads II, aVF, V5-6

Interpretation:

• Infero-postero-lateral STEMI
• Bigeminy

What happened ?

The patient was transferred for urgent angio which showed:

• LM - normal
• LAD - mild irregularities
• Cx - 100% OM1 occlusion --> stented
• RCA - long 50% stenosis
• LV gram - inferoapical hypokinesis

Post angio echo showed:

• EF 47%
• Normal LV size
• Inferolateral and anterolateral hypokineses

The patient made an uneventful post angio recovery and was commenced on DAPT, statin, ACE and beta-blocker therapy.

References / Further Reading

Life in the Fast Lane

• Inferior STEMI
• Lateral STEMI
• Posterior STEMI

Textbook

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