A 51 year old male came to the ED with ongoing chest pain since 4 hours.
There is no past medical history.
No history of Smoking and alcohol intake.
Vitals
B.P 130/70 mmHg
H.R 90/min
The ECG is displayed below.
Interpret the ECG and leave your comments in the box below.
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There is no past medical history.
No history of Smoking and alcohol intake.
Vitals
B.P 130/70 mmHg
H.R 90/min
The ECG is displayed below.
Interpret the ECG and leave your comments in the box below.
Subscribe via Email to Get Latest Cardiology MCQS directly to your inbox
Is the challenge trying to read the EKG or reading it? Sinus as it appears to be, short PR maybe low Atrial/congenital defect or a sign of this PT problem today? Poss low Atrial rhy. Bi-Gem PVC, Inf/Ant-Lat St-Segment changes Poss Sub-endocardium infarction. QRS L chest leads could suggest LVH, short PR may account for this appearance and its St segment and T Wave abberation maybe attribute to repolarization abnormality seen in LVH. Is patient on DIG? Its MI till proven other wise with this HX.
ReplyDeleteTo me the challenge with this interesting tracing is that the underlying rhythm is ventricular bigeminy (every-other-beat = a PVC). As a result - we see very few sinus beats ... I do think this is underlying sinus rhythm (upright P in lead II, albeit with a somewhat short PR interval).
ReplyDeleteOne has to look ONLY at the sinus-conducted beats to assess ST-T wave changes. These suggest a Q and slight (but real) ST elevation in lead aVL - perhaps slight ST elevation in lead aVR - and significant ST flattening and depression in multiple other leads. The T wave of sinus beats in V2,V3 is overly peaked (hyperacute vs posterior ischemia) - so my concern is ischemia - and possible posterolateral MI (subtle).
Also of note - is there is a LOT of J-point ST depression in the PVCs. While often nonspecific to try to interpret ST-T changes of ectopic beats - when this marked in the setting given of a 51yo man with 4 hours of chest pain - this to me supports he may well be infarcting!
Interesting tracing.
BELOW WHAT I WROTE ON THE CARDIOLOGY PAGE:
ReplyDelete@Mario- GOOD Comments! First - technically - I had to make a screen shot of this tracing and then blow it up to try to get a "better look" - because it is technically difficult to interpret as it is .... That said - doing the above - I was able to get a good picture.
Regarding lead V3 - it looks like it shows an rSR' complex - which is a bit of an unusual picture in lead V3 (probably because you go from very negative in V2 - to very positive in V4). There is LVH - and YES, poor r wave progression with it VERY difficult to know what to make of this (since LVH may produce PRWP and anterior MI may produce deeper-than-expected S waves in anterior leads ....). That said - it doesn't look like there is acute anterior MI ...
Given that this patient is having 4 hours of chest pain - my guess is that he will undergo acute cath - that should provide the answer. Follow-up tracings will tell us if the subtle ST elevation in aVL is part of the problem - vs significant 3-vessel or left main disease .... but NEEDS a cath - : )
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