ECG of the Week 11th January 2023 – Interpretation

This is a very ischaemic looking ECG in a high risk patient with known coronary artery disease. There is ST segment elevation in aVR, and the T waves in V1 – V3 are hyperacute. There is corresponding reciprocal change with ST segment depression in leads II, III, aVF inferiorly and leads V5 and V6 laterally. The patient is in sinus rhythm, and has a rate of approximately 70. He was beta blocked at the time.

In consultation with the cardiologist on call, the decision was made that at the time of this ECG the patient did not meet code STEMI criteria. On subsequent reviews at the bedside, the ST segment elevation became more pronounced, the patient remained diaphoretic with angina despite dual antiplatelet therapy and a heparin infusion, and was ultimately transferred to a tertiary hospital (after hours) for cath lab activation.

His coronary angiogram showed a culprit proximal LAD lesion, as well as other non-stentable lesions in his two other main vessels. His LAD lesion was stented and he was referred on to have a workup for coronary artery bypass grafting.