ECG of the Week – 20th January 2021 – Interpretation

The ECG below has been taken from an 89 year old gentleman who has just transferred from the SJA stretcher to an ED bed. He has a history of prostate cancer, IHD and Aortic Stenosis and had an episode of central chest pain with an associated collapse but is now pain free.

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ECG of the Week – 8th April 2019 – Interpretation

Following is an ECG of a 25 years old man with a four day history of left sided chest pain and its 0400 hours in the morning. He’s in a mild discomfort but looks well from the end of the bed and his observation were within normal limits. Describe the abnormalities, differential diagnosis and outline a management plan.

Interpretation:

  • Rate: 66
  • Rhythm: Sinus rhythm
  • Axis: LAD
  • Morphology:
    • 3mm STE Infr leads
    • 2mm convex STE Septolateral leads
    • STD V1
    • Pathological Q wave inferior leads
      • >1mm wide >2mm deep >25% height QRS
    • PR elevated aVR
  • Intervals: Normal PR and QRS with RBBB pattern
  • Summary: ?STEMI – Inferior septolateral ?myo-pericarditis ?coronary vasospasm (given age explore illicit drug use) ?-ve delta wave of WPW (given looks well and obs stable)

Clinical Closure:

  • Admitted to cardiology at JHC
  • Treated with aspirin / ticagrelor / heparin / analgesia
  • CXR normal
  • Trop 32000
  • Angiogram – normal coronaries with mild focal inferior hypokinesis
  • Echo – normal LV, akinesis mid inferior lateral walls, impaired systolic function EF51%, thickened infr-lateral wall (?oedema from myopericarditis), small circumferential pericardial effusion
  • Rx of aspirin, Ramipril, metoprolol, ibuprofen
  • F/u Echo in 2/12 – resolution of oedema, EF 57%