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This post is an answer to the ECG Case 242

• Rate: 72 bpm
• Rhythm: Regular Sinus Rhythm
• Axis: Normal 
• Intervals:
  • PR – Normal (180-200ms)
  • QRS – Normal (80ms)
  • QT – 360ms
• Segments:
  • ST Depression in leads I, II, aVL, V2-6
  • ST Elevation in lead aVR (~1mm)
• Additional: Markedly prominent T waves leads I, V2-6

Interpretation

De Winter’s T Wave Pattern suggesting acute LAD lesion requiring emergent reperfusion.

What happened next ?

The ECG changes were recognised by the treating team. The patient was taken for emergency PCI which showed:

• LAD – 100% Occlusion – 2 x stents inserted
• RAC – 30% proximal stenosis

Post stent echocardiogram showed:

• Mild systolic dysfunction
• Akinesis of anterior septum and apical region
• LVEF ~40-45%

The patient was discharged after a 4 day in-patient stay.

READ MORE: ECG Interpretation – All you need to know