ECG of the Week 18th August 2021

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


Rate: 72

Rhythm: Normal sinus rhythm

Axis: Normal Axis


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


  • 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.