ECG of the Week 31 August 2022 – Answer

A 81 year old male presents to a regional ED with chest pain for the last 4 hours. Below is the patients ECG:

Describe and Interpret the ECG

How would you manage this patient?


Rate: 60 beats/min

Rhythm: Normal Sinus

Axis: Normal Axis


PR: 240ms

QRS: 100ms

QT: 440ms


STE II, III, aVF, V4-5 (STE III>II), reciprocal ST depression I and aVL, TWI V2-3

This ECG shows an inferolateral STEMI with likely right sided involvement.  The patient is border line bradycardic and has a first degree heart block

The 2 main challenges in treatment of this patient is that he is in a regional area with no access to  cath lab and the patients age which puts him at higher risk complications for thrombolysis.

Management would include

  • O2 to maintain sats 94-98%
  • Aspirin 300mg po and Clopidogrel 300mg po
  • Fentanyl 25-100mcg to control pain
  • Avoid GTN, 250ml normal saline bolus as right sided STEMI preload dependent
  • Exclude contraindications for thrombolysis and appropriateness to thrombolyse patient given his age
  • Obtain consent for thrombolysis
  • Tenecteplase weight based dosage – half dose recommended in patients > 75 years old
  • Heparin bolus followed by infusion
  • Prepare for possible complications from thrombolysis – bleeding, hypotension
  • Arrange transfer to tertiary centre


Chew DP, Scott IA, Cullen L, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. The Medical journal of Australia. 205(3):128-33. 2016