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This post is an answer to the ECG Case 256

• Rate: Mean ventricular rate 96 bpm
• Rhythm:
  • Sinus complexes each followed by unifocal ventricular ectopics
    • Bigeminy
• Axis:
  • Sinus complexes
    • Normal
  • Ventricular ectopics
    • RAD

• Intervals:
  • Sinus complexes
    • PR – Normal (~160ms)
    • QRS – Normal (80ms)
    • QT – 400ms (QTc Bazette 380-400 ms)
  • Ventricular complexes
    • QRS – Prolonged (160-180ms)
• Segments:
  • Sinus Complexes
    • ST Elevation lead aVR (2mm)
    • ST Depression leads V2-6
    • Down sloping baseline makes ST segments in the inferior leads difficult to assess
  • Ventricular complexes
    • Appropriate discordant 
• Interpretation:
  • Bigeminy
  • Diffuse ST depression with ST elevation in lead aVR

What happened next ?

The patient remained in bigeminy and the ST segment changes were seen on older ECG’s. Prior angiogram showed diffuse multi-vessel disease. The patient troponin was significantly elevated and a repeat angiogram was performed during which the the left circumflex was stented.