EKG of the Week

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This EKG was done on a 58 yr old man who came to the emergency room with about 3 hours of anterior chest pain radiating to his neck and arms and associated with dyspnea and dizziness.

+ EKG Interpretation

Dr. Ohlbaum's Explanation

This EKG was done in a slightly different format. The first 3 columns are the standard ones: I, II, III, then avr, avl, avf, then V1,2,3 and last V4,5,6. There is a one lead (V1) rhythm strip on the bottom. But over on the far right, there are 3 extra leads. The top is a right sided V4- it goes on the right side at the same position as V4 goes on the left. And then 2 posterior leads V8 and V9 that are actually put on the patients back.

Look at the “regular” leads on this patient first. It is regular. There are P waves before every QRS, the rate is about 80. Nothing extra and nothing missing. So, normal sinus rhythm. The P waves look pretty normal and the PR interval is normal The QRS looks normal. But these STs are clearly not normal. He has ST elevation in the inferior leads, and in the lateral leads, suggesting the injury pattern of an acute inferolateral STEMI which it is. But look at the ST depression in V1 and V2, what do you think of that? Remember that a little ST elevation in those leads can be normal especially in men so this is very dramatic, what could do this? What about POSTERIOR injury? Look at those extra leads, the posterior leads have impressive ST elevation, too.

This is a STEMI involving a large area in infero-lateral-posterior region. The patient was sent emergently to the cath lab where he was found to have a 100% occlusion of a proximal dominant left circumflex artery just as we would expect.

The patient did well.

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