ECG Case 036

Middle-aged patient presenting with chest pain. Describe the ECG.

TOP 100 ECG QUIZ LITFL 036 2

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities

This ECG is a good example of high lateral STEMI:

  • ST elevation is confined primarily to the high lateral leads I and aVL.
  • There is reciprocal ST depression in the inferior leads II, III and aVF.
  • The deep Q waves and poor R wave progression in V1-4 suggest prior anteroseptal infarction or dilated cardiomyopathy.

High lateral STEMI is classically associated with occlusion of the first diagonal branch (D1) of the LAD, but may also occur with occlusion of the obtuse marginal branch (OM) of the circumflex artery, or the ramus intermedius.


CLINICAL PEARLS

High lateral STEMI may be extremely subtle. Sometimes the only clue is the presence of new inferior ST depression. Such localised ST depression should always be considered to be reciprocal change rather than “inferior ischaemia” as subendocardial ischaemia does not localise.


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 |

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