Wednesday, 24 May 2017

ECG of the Week - 22nd May 2017 - Interpretation

The following ECG is from a 67yr old male who presented with a 36 hour history of central chest pain and diaphoresis. He has a history of CABG. 





Click to enlarge


Rate:

  • Ventricular rate 36 bpm
  • Atrial rate ~ 60 bpm
Rhythm:
  • Regular ventricular and atrial rhythms
  • Complete heart block
Axis:
  • Normal
Intervals:
  • PR - AV dissociation with no relation between P and QRS
  • QRS - Normal
Segments:
  • ST Elevation leads II (1mm), III and aVF (3mm) V5-6 (1mm)<1mm avf="" font="" iii="" mm="" v5-6="">
  • ST Depression leads V2 - flat morphology
  • ST Depression leads I, aVF
Interpretation:

  • Infero-lateral STEMI
    • Likely posterior extension
    • Complete heart block
    • Ventricular bradycardia with narrow complex escape rhythm
What happened ?

The patient was taken for urgent angiography which showed:
  • LMCA: 80% Stenosis
  • LAD: Patent LIMA (left internal mammary artery) and SVG (saphenous vein graft)
  • Cx: Patent SVG
  • RCA: Subacute thrombotic occlusion with severe ostial and proximal vessel stenosis.
The RCA lesion was stented but the patient's recovery was complicated by repeated PEA, VT and VF cardiac arrests necessitating placement of an Intra-Aortic Balloon Pump (IABP).

A bit on IABPs

Check out the following LitFL pages for a nice overview of IABPs:


A bit on CABG anatomy and techniques

This is outside of the scope of this blog but I found the following links useful refreshers on CABG techniques and post CABG angiography / intervention:



References / Further Reading

Life in the Fast Lane

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.