ECG Case 195 Interpretation

This post is an interpretation of the ECG Case 195

Interpretation of the Initial 3 Complexes

  • Rate: ~65-68 / min
  • Rhythm: Regular
  • Axis: Normal
  • Intervals:
    • PR – Normal (~160ms)
    • QRS – Normal (100ms)
    • QT – 400ms (QTc Bazette ~420-430 ms)

  • Segments:
    • ST Depression in leads I, II, III
  • Additional: P Wave Inversion in Lead I
  • Interpretation: Ectopic Atrial Rhythm with ischemic features

Interpretation of Subsequent ECG

  • Ventricular Ectopic with ‘R-onT’ phenomenon
  • Polymorphic VT then VF

Interpretation: Acute myocardial ischaemia / infarction causing polymorphic VT / VF

Ventricular Ectopic with 'R-onT' phenomenon causing Polymorphic VT then VF
Ventricular Ectopic with ‘R-onT’ phenomenon causing Polymorphic VT then VF

What happened next ?

  • CPR
  • Received 4 x 200J shocks
  • 150mg iv amiodarone
  • 100 mg iv lignocaine

Subsequent ROSC was achieved after less than 10 minutes. Post ROSC ECG showed antero-lateral ST elevation.

The patient underwent inter-hospital transfer for PCI. PCI revealed a proximal LAD lesion with 90% occlusion, which was stented.

Echo showed:

  • Normal LV size with anterior, septal and apical akinesis and overall moderate systolic impairment
  • Probable LV apical thrombus
  • Normal right ventricular size and apical akinesis and overall mild systolic impairment.

The patient was subsequently discharged on warfarin, anti-platelet therapy, ACE inhibitor, beta-blocker, and a statin.