ECG of the Week – 9th December 2013 – Interpretation

By | 11 december 2013

This week’s ECG is from a 58 yr old male who presents to the Emergency Department c/o palpitations, dizziness, and chest pain. Symptoms onset ~90 mins prior to presentation.Past Hx – hypertension, hyperlipidaemia.
Check out the comments on our original post here.



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Rate:

  • Mean rate ~130bpm

Rhythm:

  • Irregular
  • Nil p waves

Axis:

  • Normal 

Intervals:

  • PR – Nil p waves
  • QRS – Normal (80ms)
  • QT – 280ms

Segments:

  • ST Elevation leads II (4mm), III (5mm), aVF (4mm), V4 (2mm), V5 (3mm), V6 (2.5mm)
  • ST Depression leads aVL, aVR, V1-2 (note horizontal morphology)

Additional:

  • Prominent R wave V1-2

Interpretation:

  • Infero-lateral-posterior STEMI
  • Atrial Fibrillation
    • Whilst there is a suggestion there may be group beating both our blog electrophysiologists have reviewed the ECG and agree this is ‘simple’ atrial fibrillation

What happened ?

The ECG findings were immediately recognised and local PCI protocol was activated.
The angiogram showed:

  • LAD – 70% mid-stenosis
  • PLA – 100% ostial occlusion –> Stented
  • LV function preserved

Echocardiogram:

  • Inferolateral LV akinesis
  • Normal RV size and function

The patient’s recovery was complicated by acute stent thrombosis requiring re-stent. He was discharge following a 4 day in-patient stay.

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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