ECG of the Week - 30th October 2017 - Interpretation

The following ECG is from a patient complaining of acute onset chest pain.

Click to enlarge

Rate:

• 84 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal
• QRS - Normal

Additional:

• ST Elevation leads II (2mm), III (3mm), aVF (3mm), V3-6 (<1mm font="">
• ST Depression leads I, aVR, aVL, V1-2
• V1-3 initial R wave but R/S ratio is <1 font="">

Interpretation:

• Inferior STEMI

Main consideration specific for patients with an inferior STEMI are:

• Initiate urgent re-perfusion
• Is there evidence of AV block ?
• Is there evidence of right ventricular involvement ?

ECG features that support RV involvement on this ECG is the presence of ST elevation III>II and ST depression in lead I. The potential for posterior involvement is raised by the flat ST depression seen in leads V1-2. Whilst concurrent activation of re-perfusion protocol was underway both right and posterior ECG's were performed.

Click to enlarge 

Click to enlarge

There is subtle ST elevation in the right leads with no ST elevation in the posterior leads.
I unfortunately don't have the patient's details to give you a conclusion from the angio report.
References / Further Reading

Life in the Fast Lane

• Inferior STEMI
• Inferior STEMI Right ventricular involvement

Textbook

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