ECG Case 039

Elderly patient presenting with chest pain. BP 80/50. Describe the ECG.

TOP 100 ECG QUIZ LITFL 039 2

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

This ECG shows extensive infero-postero-lateral STEMI with “tombstone” morphology:

There are some additional features suggest of right ventricular infarction:

  • STE in lead III > lead II.
  • Deep ST depression in V2 with an isoelectric ST segment in V1.

This is a huge infarct with a likely poor prognosis. Hypotension may be due to nitrate therapy causing exaggerated preload reduction in the context of RV infarction, or may simply reflect the large infarct size with development of early cardiogenic shock.


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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