ECG of the Week – 18th November 2013 – Interpretation

By | 20 november 2013

This week’s ECG is from a 65 yr old male who presents with chest pain.
Intermittent exertional chest pain over the preceding week .
Continuous chest pain for the last hour with dysponea and diaphoresis.
Past history of hypertension. Non smoker with no family history.
Check out the comments on our original post here.




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Rate:

  • 78

Rhythm:

  • Regular
  • Sinus rhythm

Axis:

  • LAD (-35 deg)

Intervals:

  • PR – Normal (~140ms)
  • QRS – Normal (100ms)
  • QT – 380ms (QTc Bazette ~ 430 ms)

Segments:

  • ST Elevation leads aVR (1mm) V1 (2mm), V2 (4mm), V3 (3mm), V4 (2mm)
  • ST Depression leads I, II, V6

Additional:

  • Small q wave leads aVL, V2, V3
  • Prominent ‘hyperacute’ Twaves leads V1-4

Interpretation:

  • Acute Anterior STEMI

What Happened ?

The patient was transferred for immediate PCI which showed:

  • Mid-LAD 100% Occlusion –> Stented
  • All other vessels normal
  • Apical akinesis on ventriculogram

The patient was discharged following a 3 day in-patient stay.

References / Further Reading

Life in the Fast Lane

  • Anterior STEMI here

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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