ECG of the Week – 28th April 2021 – Interpretation

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A 68 year old female presents to ED complaining of chest pain radiating to both arms. Below is the patients ECG:

Answer:

Rate: 90 beats per minute

Rhythm: Normal Sinus Rhythm

Axis: Normal Axis

Intervals

  • PR 120ms
  • QRS 80ms
  • QTc 490ms (Bazett)

Additional:

  • Bifid broad P waves – indicative of LA enlargement. No Voltage criteria for LV enlargement
  • Global ST depression
  • ST elevation 2mm aVR

The above ECG shows diffuse ST depression and ST elevation in aVR. The differential diagnosis for this would include:

  • Subendocardial Ischaemia due to shock, anaemia, sustained tachycardia
  • Severe Coronary Disease – due to triple vessel disease, left main or proximal LAD disease

In this clinical context there should be concern about severe coronary disease.

STE in aVR > 1mm in the context of symptoms of myocardial ischaemia and widespread ST depression, is predictive LMA and LAD disease as well as need for a CABG

 

This ECG is a STEMI equivalent, and urgent cardiology consult should be sort for this patient.

 

Further reading:

Dr Smiths ECG Blog – https://hqmeded-ecg.blogspot.com/search/label/left%20main