ECG of the Week - 26th March 2018 - Interpretation

The following ECG is from a 45 yr old male who presents following an Out-of-Hospital Cardiac Arrest (OOHCA). He regained cardiac output en route to the Emergency Department.

Click to enlarge

Rate:

• 96 bpm

Rhythm:

 

• Irregular
• Nil P waves 

Axis:

• LAD

Intervals:

• QRS - Normal

Segments:

• ST Elevation leads I (6mm), aVL (7mm), V6 (1mm)
• ST Depression leads II, III, aVR, aVF, V1-5

Additional:

• Late R wave transition

Interpretation:

• High lateral STEMI
• Atrial fibrillation 

What happened ?

The patient was transferred for urgent angiography and underwent stenting of a 1st Diagonal branch occlusion.

 

Further reading

 

All EM Physicians should be aware of their relevant National resuscitation guidelines.

The Australian Resuscitation Council has a set of comprehensive guidelines which can be found here:

• https://resus.org.au/guidelines/

 Here is a concise and quick review regarding some of the key considerations in a post-ROSC care plan from R.E.B.E.L.EM:

• http://rebelem.com/topics-in-post-rosc-care/

 References / Further Reading

 

Life in the Fast Lane

 

• High Lateral STEMI

Textbook

 

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