ECG of the Week – 18th July 2016 – Interpretation

The following ECG is from a 28 yr old female who is 20 weeks pregnant. She presented complaining of dysponea and chest pain.


Click to enlarge

Rate:
  • 72 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal (-33 deg)
Intervals:
  • PR - Short (80ms)
  • QRS - Prolonged (120ms)
  • QT - 400ms (QTc Bazette 380-400 ms)
Segments:
  • Nil significant changes
Additional:
  • Delta waves leads I, aVL
  • Deep Q wave leads III, aVF
  • T wave inversion leads aVL, V1, V2, aVR
  • Voltage criteria LVH
    • R wave aVL >11mm
Interpretation:
  • Pre-excitation (WPW)
    • Deep Q waves in inferior leads mimic old inferior MI referred to as pseudo-infarction pattern this is due to pre-excitation and does not reflect prior ischaemia.
    • AP location is postero-septal tricuspid annulus using Arruda algorithm
What happened ?

The patient had known WPW, it would spoil the fun if I told you that in advance. She was investigated from a possible PE which was negative and discharged.

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 – 11th July 2016 – Interpretation

The following ECG is from a 38 yr old male who presented complaining of chest pain. Current smoker but nil medical or family history.




Click to enlarge
Rate:
  • 66
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal (-33 deg)
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (100ms)
  • QT - 380ms (QTc Bazette 380-400 ms)
Segments:

  • Subtle ST depression leads V4-6

Additional:

  • Deep T wave inversion lead III
  • Biphasic T wave lead aVF
  • Prominent T waves leads I, aVL (of equal or greater height than QRS)

Interpretation:

  • Very suspicous ECG for ACS


What happened ?

The patient had serial ECG's which showed dynamic T wave changes in the inferior leads and T wave amplitude antero-laterally. Serial troponins were positive.
The patient underwent angiography which showed:
  • LMCA: Minor irregularities
  • LAD: Mid 99% single discrete lesion
  • Ostial 1st Diagonal: 90% single discrete lesion
  • CX: Irregularities
  • RCA: Irregularities
A stent was inserted to the LAD lesion and the ostial lesion was treated with balloon angioplasty. Echo showed normal systolic and valvular function.
The patient was commenced on dual anti-platelet therapy (DAPT), statin, ACE and beta-blocker therapy.

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.