ECG Case 71: Atrial fibrillation with RVR, LAFB and Acute Anterolateral STEMI

ECG Interpretation

  • Atrial fibrillation with a ventricular rate of about 180/min
  • Left axis deviation
  • Probable Q (QS) waves in leads V2–V4
  • QRS complexes of normal width and height
  • Raised ST segments in leads I, aVL, V1–V4 with reciprocal ST depression in leads II,III and aVF

Atrial fibrillation with RVR, LAFB and Acute Anterolateral STEMI
Atrial fibrillation with RVR, LAFB and Acute Anterolateral STEMI

Clinical Interpretation

This ECG shows uncontrolled atrial fibrillation with left anterior hemiblock and an acute anterolateral ST segment elevation myocardial infarction (STEMI).

The onset of atrial fibrillation may have been the cause or the consequence of the myocardial infarction, and the rapid ventricular rate will at least in part explain the pulmonary oedema. The left anterior hemiblock is probably a consequence of the infarction. The patient may not have experienced pain because of his diabetes.