60yr old male who had an out-of-hospital cardiac arrest. Return of spontaneous circulation was attained prehospital.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
- 120 bpm
- Regularly irregular
- Alternating sinus complex and PVC
- Sinus complex – normal axis
- PVC – extreme axis
Intervals- Sinus Complex:
- PR – Normal (~200ms)
- QRS – Normal (100ms)
- QT – 480ms
- QRS – Prolonged (120ms)
Segments – Sinus complexes:
- ST Elevation leads V2 (2mm) V3 (3mm) V4 (2mm) V5 (2mm) V6 (1mm)
- T inversion lead aVL
- Hyperacute T waves leads V2-4
- Excessive discordant ST elevation in the PVC’s leads V2-6 – see edited ECG’s below
- Anterolateral STEMI
The patient was taken for urgent angiography and PCI and has a mid-LAD lesion stented.
Whilst the key features on this ECG and reasonably apparent the presence of frequent PVC can distract the eye and male interpretation difficult. I’ve edits the ECG below to show only the sinus complexes.
The ECG below is edited to only show the PVC’s as they exhibit excessive discordant ST elevation due to concurrent infarction.