ECG of the Week - 25th December 2017 - Interpretation

The following ECG's are from a 89 yr old female who presented with chest pain. She has a history of 2nd degree AV block with PPM in-situ.

ECG on arrival
Click to enlarge

Key features:

• Rate 60 bpm
• Regular V-paced rhythm
• LBBB Morphology
• Discordant ST / T wave changes
• T waves in leads V2-4 appear prominent
• Concordant ST elevation in lead I with a positive QRS
• Subtle and easy to miss

ECG 60 mins later
Further chest pain
Click to enlarge 

Key features:

• Rate 60 bpm
• Regular V-paced rhythm
• LBBB Morphology
• Significant progression of ST and T wave changes
• Massive ST elevation (>5mm) in leads V2-4 also proportionately >25% of QRS depth
• Discordant ST elevation in leads II, III, aVF, V5
• Significantly more pronounced than on previous ECG
• Concordant ST elevation in leads I and V6

Interpretation:

• Sgarbossa positive ECG's
• Dynamic and progressive ST segment changes
• Underlying V-paced rhythm with LBBB morphology

What happened ?

The patient was discussed with the cardiology team and taken for angiography.
This showed an acute mid LAD occlusion treated with a bare metal stent. Post angiography echo showed moderate systolic and diastolic dysfunction. She was discharged following a 2 day in-patient stay.

References / Further Reading

Life in the Fast Lane

• Sgarbossa Criteria

Textbook

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