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This post is an interpretation of the ECG Case 204

• Rate: ~108 bpm
• Rhythm:
  • Sinus rhythm
  • Frequent PVCs
    • Unifocal
    • Single & Couplets
    • Evidence of compensatory pauses
• Axis:
  • Sinus Complexes – Normal (+70 deg)
  • PVC – LAD

• Intervals:
  • PR – Normal (~180ms)
  • QRS – Sinus Complexes – Normal (100ms)
  • QRS – PVCs – Prolonged (120-140ms)
  • QT – 320ms (QTc Bazette ~ 420 ms)
• Segments:
  • ST Elevation in Leads:
    • II (1mm), III (2mm), aVF (3mm)
    • ? V6 (0.5mm) – single complex with uneven baseline
  • ST Depression in Leads aVL, V1-3
• Additional:
  • T wave inversion in aVR, aVL, V1-3
  • P wave inversion in Leads aVR, V1-2
  • R wave in V1-3
  • PVCs – Discordant T wave & ST segment changes

Interpretation

Acute Inferior and Posterior OMI

What happened next ?

The ECG features were immediately recognized and STEMI protocol was activated. The patient underwent an uneventful transfer for PCI which revealed a 100% occlusion of the proximal RCA which was stented.

The patient was commenced on aspirin, prasugrel, statin, ACE, and beta-blocker therapy. He was discharged after a 3 day in-patient stay.

READ MORE:

• ECG Interpretation: All you need to know
• Know the Differential for ST Segment Elevation: It’s More Than Just ACS

SIMILAR CASES:

• ECG Case 191: Inferior and Posterior Wall MI
• ECG Case 179: Acute Inferior and Posterior STEMI
• ECG Case 173: Inferior Wall STEMI with Posterior Wall Involvement
• ECG Case 124: Acute Inferior and Posterior Wall MI and Monomorphic Nonsustained VT