ECG Case 001

Middle-aged patient presenting with chest pain and diaphoresis. BP dropped to 80/50 following sublingual nitrates.

TOP 100 ECQ QUIZ LITFL 001

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

General:

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:

TOP 100 ECQ QUIZ LITFL 001b

CLINICAL PEARLS
  • 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


TOP 100 ECG SERIES



Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

2 Comments

  1. Dr. Burns
    I find a interesting aspect in the ecg: ST ELEVATION V2>V3>V4
    It’s important to know the result of coronariogram. Please give us this date. Thanks

  2. ahmed abdulkarim
    ahmed abdulkarim

    It seems to be an occlusion of a big dominant RCA with PDA rapping around the apex causing antero-inferior MI

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