ECG of the Week - 3rd December 2018 - Interpretation

The following ECG is from a 53 yr old male who presented to the Emergency Department following an episode of chest pain and shortness of breath. On arrival the patient was pain free and the following ECG was performed.

Click to enlarge

Rate:

• 48 bpm

Rhythm:

• Regular 
• Sinus Rhythm 

Axis:

• Normal

Intervals:

• PR - Normal (~130ms)
• QRS - Normal

Additional:

• Partial RBBB morphology
• Biphasic T wave lead II
• T wave inversion lead III, aVF
• Large prominent T wave lead V2

Interpretation:

• ECG pattern suggesting reperfusion in infero-basal territory
• Reperfusion T wave inversion inferior leads
• Prominent T wave in V2 secondary to basal reperfusion (posterior T inversion seen as T wave increased size reciprocally)

What happened ?

• The patient was taken for PCI which revealed a critical stenosis of the RCA which was stented.

 

References / Further Reading

 

Dr Smith's ECG Blog 

• Inferior Reperfusion T wave case

Textbook

 

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