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.


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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

Textbook

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

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