ECG of the Week - 19th February 2018 - Interpretation

The following ECG is from a 57 yr old male who presented to the Emergency Department complaining of chest pain for 1 hour. He is an ex-smoker and has a history of hypertension and hypercholesterolaemia.

Click to enlarge

Rate:

• Mean ventricular rate 84 bpm

Rhythm:

• Irregular
• Absent p waves

Axis:

• Normal

Intervals:

• QRS - Normal (100ms)

Segments:

• ST Elevation leads II (1-2mm) III (3mm) aVF (2mm)
• ST Depression leads I, aVL, V2-6

Additional:

• T wave inversion leads I, V3-6
• Biphasic T wave leads aVL, V2
• R/S ratio V2 >1
• Voltage criteria for LVH

Interpretation:

• Infero-posterior STEMI
• Atrial fibrillation

What happened ?

The patient was transferred for urgent angiography which showed:

• Left main - Normal
• LAD - Normal
• Left circumflex - 70% Mid-Cx lesion --> stented
• RCA - Normal

Post angiography echo showed severe aortic stenosis, dilated left atrium, increased LV wall thickness / mass and hypokinesis to to left ventricle.

References / Further Reading

Life in the Fast Lane

• Inferior STEMI
• Posterior STEMI 

Textbook

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