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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- Mean rate ~130bpm
- Nil p waves
- PR – Nil p waves
- QRS – Normal (80ms)
- QT – 280ms
- 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)
- Prominent R wave V1-2
- 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
- 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
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.