ECG Case 084

89 yr old female presents with chest pain. She has a history of 2nd degree AV block with PPM in-situ.

Serially ECGs were recorded

ECG 1; on arrival pain 3/10

ECG Case 084a LITFL Top 100 EKG
ECG on arrival; pain 3/10

ECG 2; 60 mins later with a further bout of chest pain 8/10

ECG Case 084b LITFL Top 100 EKG
ECG 2; 60 mins later with further chest pain

Describe and interpret these ECGs


Key features:

  • Rate 60 bpm
  • Regular V-paced rhythm
  • LBBB Morphology
  • Discordant ST / T wave changes
  • T waves in leads V2-4 appear prominent
  • Concordant ST elevation in lead I with a positive QRS
    • Subtle and easy to miss


Key features:

  • Rate 60 bpm
  • Regular V-paced rhythm
  • LBBB Morphology
  • Significant progression of ST and T wave changes
    • Massive ST elevation (>5mm) in leads V2-4 also proportionately >25% of QRS depth
    • Discordant ST elevation in leads II, III, aVF, V5
      • Significantly more pronounced than on previous ECG
    • Concordant ST elevation in leads I and V6


Sgarbossa positive ECG’s

  • Dynamic and progressive ST segment changes
  • Underlying V-paced rhythm with LBBB morphology

The patient was discussed with the cardiology team and taken for angiography.

This showed an acute mid LAD occlusion treated with a bare metal stent. Post angiography echo showed moderate systolic and diastolic dysfunction. She was discharged following a 2 day in-patient stay.


TOP 100 ECG Series

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

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