A 65 year old male presents with SOB over the last 2 days. The patient has a background of diabetes and hypertension.

Describe and Interpret the ECG

Answer

Rate: 72

Rhythm: Normal sinus rhythm

Axis: Normal Axis

Intervals

• PR 120ms
• QRS 100ms
• QTc 394 Bazett

Additional:

• Bifid P waves
• Spikes prior to P waves ? artifact (patient did not have PPM)
• STE 1mm V1 and aVR
• ST depression V2 and V3
• Dominant R wave V2 and V3
• TWI laterally I, aVL, and V6

The above ECG is highly suggestive of a posterior ischaemia. In the context of the patient being diabetic, it would be concerning for a silent MI. Isolated posterior wall infarcts are uncommon, and need to be actively looked for and considered when one is considering ischaemia.