ECG Case 009
55-year old patient presenting with chest pain
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
This ECG is an example of hyperacute anterolateral STEMI:
- There are markedly peaked, asymmetrical T waves (= hyperacute T waves) in V2-5
- The associated loss of R wave height (analogous to early Q wave formation) causes the enlarging precordial T waves to tower over the diminishing R waves
- There is also some subtle ST elevation in aVL, indicating LAD occlusion proximal to the D1
- There are frequent ventricular ectopic beats, which are concerning in this context as they suggest underlying myocardial irritability and a risk of deterioration to malignant ventricular dysrhythmias such as VF or VT
CLINICAL PEARLS
Serial ECGs of this patient showed evolving anterolateral ST elevation (V1-6, I, aVL) with development of inferior reciprocal change (lead III).
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 |
MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner