ECG Case 089
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
Rate:
- 120 bpm
Rhythm:
- Regularly irregular
- Bigeminy
- Alternating sinus complex and PVC
Axis:
- Sinus complex – normal axis
- PVC – extreme axis
Intervals- Sinus Complex:
- PR – Normal (~200ms)
- QRS – Normal (100ms)
- QT – 480ms
Intervals- PVC’s:
- QRS – Prolonged (120ms)
Segments – Sinus complexes:
- ST Elevation leads V2 (2mm) V3 (3mm) V4 (2mm) V5 (2mm) V6 (1mm)
Additional:
- 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
Interpretation:
- Anterolateral STEMI
- Bigeminy
OUTCOME
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.
FURTHER READING
- ECG Library – Anterior Myocardial Infarction
- ECG Library – Lateral STEMI
- ECG Library – Premature Ventricular Complex (PVC)
TOP 100 ECG Series
Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |