ECG Case 072

This ECG is from a 49 year old. He self-presented to the emergency department with chest pain, initial ECG is below.

ECG Case 072

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Initial 3 Complexes

  • Rate: ~65-68
  • Rhythm: Regular
  • Axis: Normal

Intervals:

  • PR – Normal (~160ms)
  • QRS – Normal (100ms)
  • QT – 400ms (QTc Bazette ~420-430 ms)

Segments:

  • ST Depression I, II, III

Additional:

  • P Wave Inversion Lead I

Interpretation:

  • Ectopic Atrial Rhythm with ischaemic features

Subsequent ECG

  • Ventricular ectopic with ‘R-onT’ phenomenon
  • Polymorphic VT –> VF

Interpretation:

  • Acute myocardial ischaemia / infarction causing polymorphic VT / VF

What happened next ?

  • CPR
  • Received 4 x 200J shocks
  • 150mg iv amiodarone
  • 100 mg iv lignocaine

Subsequent ROSC was achieved after < 10 minutes. Post ROSC ECG showed antero-lateral ST elevation.The patient underwent inter-hospital transfer for PCI.PCI revealed a proximal LAD lesion with 90% occlusion, which was stented. 
Echo showed

  • Normal LV size with anterior, septal and apical akinesis and overall moderate systolic impairment
  • Probable LV apical thrombus
  • Normal right ventricular size and apical akinesis and overall mild systolic impairment.

The patient was subsequently discharged on warfarin, anti-platelet therapy, ACE inhibitor, beta-blocker, and a statin.


CLINICAL PEARLS

Things to think about

  • The role of early revascularisation with thrombolysis prior to inter-hospital transfer
  • The role of lignocaine/lidocaine in shock refractory VT/VF
    • Several International Guidelines on ALS are linked to below and the recommendations on the use of lignocaine vary between guidelines

TOP 150 ECG SERIES



Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |

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