ECG Case 59: Atrial Fibrillation with Rapid Ventricular Response (RVR) and Diffuse Subendocardial Ischemia - Manual of Medicine

ECG Case 59: Atrial Fibrillation with Rapid Ventricular Response (RVR) and Diffuse Subendocardial Ischemia

Post category:ECG Interpretations / ECGs
Post published:February 13, 2022

This post is an interpretation of the ECG Case 59

ECG Interpretation

Atrial Fibrillation with Rapid Ventricular Response (RVR)
Average ventricular rate 120/min
Normal axis
Normal QRS complexes
Diffuse ST segment depression in leads V2–V6, I, II, aVF, aVL
Reciprocal ST elevation in lead aVR

Atrial Fibrillation with Rapid Ventricular Response (RVR) and Diffuse ST Depression that indicates Subendocardial Ischemia

Clinical Interpretation

The diffuse ST segment depression indicates subendocardial ischemia that could be due to:

Three vessel disease (3VD)
Left main artery stenosis
Demand Ischemia (from hypoxia, anemia, shock, sepsis, PE, trachyarrhythmias, etc)

In this case the subendocardial ischemia is probably due to supply/demand mismatch (low supply because of the heart failure and high demand because of the atrial fibrillation with rapid ventricular response)

This patient needs rate control with drugs to reduce the heart rate and to see if the ST depression resolves. If it doesn’t resolve, other causes should be sought out.

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