ECG Case 009

55-year old patient presenting with chest pain

TOP 100 ECG QUIZ LITFL 009 2

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 QUIZ LITFL 009 2b


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

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