Middle-aged patient presenting with chest pain and diaphoresis. Becomes unresponsive during recording of ECG. Interpret the ECG.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
This is a fascinating ECG with multiple abnormalities:
- The first half of the tracing shows a ventricular paced rhythm with positive Sgarbossa criteria indicating superimposed inferior STEMI.
- There is excessively discordant ST elevation (> 25% of Q/S wave depth) in II, III and aVF with reciprocal change in I and aVL.
- A ventricular ectopic (beat #8) occurs at a vulnerable time, resulting in a run of ventricular flutter (very rapid VT at rates > 200-300 bpm).
- This rapidly degenerates to ventricular fibrillation (seen in the rhythm strip, which is recorded after the other 12 leads).
- The artefact at the start of the rhythm strip may represent a precordial thump!
While most rhythm strips are recorded simultaneously with the 12-lead ECG, some older machines may record the rhythm strip after the other 12 leads.
Consider this as a possibility if your rhythm strip doesn’t seem to “line up” with the rest of the ECG.