Middle-aged patient presenting with chest pain and diaphoresis. BP dropped to 80/50 following sublingual nitrates.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
- Sinus rhythm, rate 84bpm.
- Normal axis.
- Borderline 1st degree AV block (PR 220ms).
Signs of inferior STEMI:
- STE in inferior leads II, III, aVF.
- Reciprocal STD in lateral leads I, aVL, V6.
Signs of associated right ventricular infarction:
- STE in III > II.
- STE in V1-2.
This patient also had STE in V4R, confirming the diagnosis of RV infarction:
- RV infarction typically occurs in the context of inferior STEMI due to RCA occlusion.
- These patients are preload sensitive and may have an exaggerated hypotensive response to nitrates.
Read more about RV infarction and how to record the V4R lead