60yr old male who had an out-of-hospital cardiac arrest. Return of spontaneous circulation was attained prehospital.

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Rate:

Rhythm:

  • Regularly irregular
  • Bigeminy 
    • Alternating sinus complex and PVC

Axis:

  • Sinus complex – normal axis
  • PVC – extreme axis

Intervals- Sinus Complex:

  • PR – Normal (~200ms)
  • QRS – Normal (100ms)
  • QT – 480ms

Intervals- PVC’s:

Segments – Sinus complexes:

  • ST Elevation leads V2 (2mm) V3 (3mm) V4 (2mm) V5 (2mm) V6 (1mm)

Additional:

  • T inversion lead aVL
  • Hyperacute T waves leads V2-4
  • Excessive discordant ST elevation in the PVC’s leads V2-6 – see edited ECG’s below

Interpretation:

  • Anterolateral STEMI
  • Bigeminy

OUTCOME

The patient was taken for urgent angiography and PCI and has a mid-LAD lesion stented.

Whilst the key features on this ECG and reasonably apparent the presence of frequent PVC can distract the eye and male interpretation difficult. I’ve edits the ECG below to show only the sinus complexes.

ECG Case 089b LITFL Top 100 EKG
ECG with only sinus complexes shown

The ECG below is edited to only show the PVC’s as they exhibit excessive discordant ST elevation due to concurrent infarction.

ECG Case 089c LITFL Top 100 EKG
ECG with only PVC’s shown

Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |