This post is an answer to the ECG Case 305
- Rate: Mean ventricular rate 90 bpm
- Rhythm: Bigeminy
- Regularly irregular
- Sinus complex followed by premature complex fixed ratio
Sinus Complexes
- Axis: Normal
- Segments:
- ST Elevation leads in II (1mm), III (2mm), aVF (2mm), V6 (1mm)
- ST depression in leads V1-4, aVL
- Additional:
- rSr’ pattern in V1
- Hyperacute T waves lead V5,V6, II, III, aVF
- T inversion in leads aVL, V1-2
Premature Complexes
Key features:
- LAD
- QRS – Prolonged (120ms)
- Excessive discordant ST elevation in leads II, aVF, V5-6
- Excessive discordant ST depression in lead V1
Interpretation
- Infero-postero-lateral STEMI
- Bigeminy
What happened next ?
The patient was transferred for urgent angio which showed:
- LM – normal
- LAD – mild irregularities
- Cx – 100% OM1 occlusion – stented
- RCA – long 50% stenosis
- LV gram – inferoapical hypokinesis
Post angio echo showed:
- EF 47%
- Normal LV size
- Inferolateral and anterolateral hypokineses
The patient made an uneventful post angio recovery and was commenced on DAPT, statin, ACE and beta-blocker therapy.
