EKG of the Week

A 61 year-old male with no significant past medical history presented to the ED with one hour of substernal chest pain. He has no prior EKGs. His EKG from the ED is shown below

+ EKG Interpretation

Answer to the EKG

There are clear P waves, and every P wave is followed by a QRS, nothing missing and nothing extra. The rate is around 80 bpm so it is normal sinus rhythm. The P wave is normal. The PR is normal.

What about the QRS? He has a left axis and there may be some tiny Q's in the inferior leads.

However, the big thing is when you start looking at the ST and T's. He has about 2mm ST elevation in the inferior leads (II, III, aVF) which corresponds to an inferior injury. This is a STEMI involving the inferior wall.

You also have a 15 lead EKG that was run in the ED. Look at the right hand column. There is also a convex ST elevation in right sided V4. This suggests a RV infarct as well.

What's the immediate treatment for this patient? Cath lab! He had a 100% occlusion of the distal RCA!

Further Reading:

Life in the Fast Lane: Inferior STEMI

Follow up EKGs:

Full EKG Index