ECG of the Week: ECG of the Week - 10th July 2017

Wednesday, 12 July 2017

ECG of the Week - 10th July 2017 - Interpretation

The following ECG is from a 52 yr old who presented to a remote medical center, 360km from the nearest tertiary hospital, with chest pain for 1 hour.

Click to enlarge

Rate:

66 bpm

Rhythm:

Regular
Ectopic atrial rhythm

Inverted P waves in inferior leads

Axis:

Normal

Intervals:

PR - Normal
QRS - Normal

Additional:

Marked ST elevation leads II (5mm), III (6mm), aVF (6mm)
ST Depression leads I, aVR, aVL, V1-6
T wave inversion leads aVR, aVL, V1-2
Biphasic T wave leads V3-5

Interpretation:

Inferior STEMI

Likely posterior extension

Given the remote location this patient was thrombolysed and subsequently transferred for further tertiary management. I don't have the results of his subsequent angiogram or echo unfortunately.

What are the contraindications to thrombolysis ?

If you work in a metropolitan or tertiary center you probably send all your STEMI's for urgent angiography but it remote and rural centers thrombolysis must be considered.

The following list is taken from the Australian Resuscitation Council Guideline 14.3 'Acute Coronary Syndromes: Reperfusion Strategy'.

Contraindications to thrombolysis in STEMI

ARC Guideline 14.3

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What agents can you use and how are they given ?

Streptokinase 1.5 million units iv over 60 minutes
Alteplase initial iv bolus plus variable dose infusion over 90 minutes
Reteplase 10 units iv over 2 minutes followed 30 minutes later by a further 10 units iv over 2 minutes
Tenecteplase 30-50mg iv bolus depending on patient's weight

What are the complications of thrombolysis for STEMI ?