ECG of the Week - 27th March 2017 - Interpretation

This ECG is from a 63yr old male who presented with chest pain. He has a 1 month history of exertional chest pain and continuous chest pain for the last 3 hours. He is a hypertensive, ex-smoker with a positive cardiac family history.

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Rate:

• 72 bpm

Rhythm:

• Regular
• Sinus Rhythm

Axis:

• Normal

Intervals:

• PR - Normal (~160ms)
• QRS - Normal (100ms)
• QT - 360ms

Segments:

• ST Elevation leads aVR (1mm) aVL (1mm) V1 (1mm)
• ST Depression leads II, III, aVF, V4-6

Additional:

• Prominent  U-wave in antero-septal leads
• T wave inversion infero-lateral leads
• Down-up morphology may be due to prominent U waves

Interpretation:

• Acute ACS
• Patient with history suspicious of ACS
• ST / T changes indicative of ACS

What happened ?

The patient was taken for urgent angiography which showed:

• Right dominant system
• LM: 50% distal
• LAD: 90% proximal
• Cx: 90% mid
• RCA: 99% distal RCA with 80% ostial - TIMI 3 flow & pain-free patient
• RCA: Supplying large PDA and 3 PLV branches
• LH Cath: Inferior akinesis with mild LV impairment

The patient was then transferred to tertiary centre for urgent CABG given severe multi-vessel disease.

References / Further Reading

Life in the Fast Lane

• ST Segment Changes

Textbook

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