ECG Case 204 Interpretation

This post is an interpretation of the

  • 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
Acute Inferior and Posterior OMI

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.

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