ECG of the Week – 16th January 2017

These ECG’s are from a 62yr old male who was under out-patient investigation following an episode of chest pain. He was referred to the Emergency Department after completing an exercise stress test in which he became symptomatic with chest pain. On arrival to the Emergency Department he was pain free.





ECG during EST
Chest pain
Click to enlarge

ECG on arrival to ED
Pain free
Click to enlarge



Things to think about

  • What are the key ECG features on his ECG’s ?
  • How would you manage this patient ?

ECG of the Week – 9th January 2017 – Interpretation

This ECG is from a 59 yr old male who presented with episodic chest pain for the last 2 weeks which had been constant for the last 1 hour. He has a past medical history of hypertension.

 

 
Click to enlarge

Rate:

  • ~125 bpm

Rhythm:

  • Regular
  • Sinus Rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~180ms)
  • QRS – Normal (60ms)

Segments:

  • ST Elevation leads: I (0.5-1mm), aVL (1mm), V1 (1mm), V2 (8-9mm), V3 (4mm), V4 (1mm)
  • ST Depression leads: II, III, aVF, V5-6

Interpretation:

  • Anterior STEMI
 What happened ?

The patient was transferred for urgent angio which showed:

  • Left main 40% ostial lesion
  • LAD diffuse disease with severe mid disease and severe distal disease – PCI with DES x 2
  • Cx severe ostial
  • RCA Diffuse mild-mod disease

Post procedure echo:

  • Mod-severe segmental dysfunction with extensive anterior wall akinesis – EF 37%
  • No significant valvular dysfunction

The patient had an uneventful further in-patient stay.

References / Further Reading
 
Life in the Fast Lane

Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

ECG of the Week – 9th January 2017 – Interpretation

This ECG is from a 59 yr old male who presented with episodic chest pain for the last 2 weeks which had been constant for the last 1 hour. He has a past medical history of hypertension.

 

 
Click to enlarge

Rate:

  • ~125 bpm

Rhythm:

  • Regular
  • Sinus Rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~180ms)
  • QRS – Normal (60ms)

Segments:

  • ST Elevation leads: I (0.5-1mm), aVL (1mm), V1 (1mm), V2 (8-9mm), V3 (4mm), V4 (1mm)
  • ST Depression leads: II, III, aVF, V5-6

Interpretation:

  • Anterior STEMI
 What happened ?

The patient was transferred for urgent angio which showed:

  • Left main 40% ostial lesion
  • LAD diffuse disease with severe mid disease and severe distal disease – PCI with DES x 2
  • Cx severe ostial
  • RCA Diffuse mild-mod disease

Post procedure echo:

  • Mod-severe segmental dysfunction with extensive anterior wall akinesis – EF 37%
  • No significant valvular dysfunction

The patient had an uneventful further in-patient stay.

References / Further Reading
 
Life in the Fast Lane

Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.