ECG #6


Interpretation

 

Rate:

Atrial = 129 min-1

Ventricular = 129 min-1

Rhythm:

Sinus tachycardia

P waves:  

Duration = 60 ms

Amplitude = 0.05 mV

PR interval:

Duration = 190 ms

Morphology = Normal

QRS complex:

Duration = 78 ms

Axis = 50°

Q Waves:

III

R wave progression:

Normal

LV Hypertrophy [Sokolow; SV1 + (RV5 or RV6) > 35mm) or RI + SIII > 25mm]?

No

RV Hypertrophy [R/S ratio V5 or V6 < 1 or R/S ratio V1 > 1 or S1S2S3 pattern]?

No

ST segments:

Duration = 90 ms

Morphology = elevation III, aVR, V1; depression I, II, aVL, V3-6

T waves:

Duration = 120 ms

Morphology = normal

QT interval:

QT duration = 288 ms

QTc duration = 421 ms

Additional comments:

Nil


Interpretation: The combination of ST elevation in avR and depression in six or more other leads suggests an acute left main insufficiency. This 36 year old male with a history of personality disorder and polysubstance abuse was witnessed to be acting “oddly”. When wrestled to the ground by several people, including the police, he was found to be in cardiac arrest. CPR was commenced and St. John’s Ambulance paramedics restored sinus rhythm by electrical cardioversion with return of spontaneous circulation (ROSC). Unfortunately the patient had established global cerebral ischaemia (on CT brain), and was not a candidate for coronary reperfusion.

 

ECG #6
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