EKG of the Week

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This is an EKG on a 61 year old man with no significant past history, who presented to the ED with one hour of substernal chest pain. We have no prior EKGs. 

+ EKG Interpretation

Dr. Ohlbaum's Explanation

There are clear P waves, and every P is followed by a QRS, nothing missing and nothing extra. The rate is around 80 so it is NSR. 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 of ST elevation in the inferior leads (11,111, and AVF)➔inferior injury. This is a STEMI involving the inferior wall. I also gave you the 15 lead EKG that was run in the ED, look in the right hand column. There is also a convex ST elevation in right sided V4. That suggests RV infarct as well.

What is the immediate treatment for this patient ? Cath lab! He had 100% occlusion distal RCA with clot.

Further Reading:

Life in the Fast Lane: Inferior STEMI

Follow up EKGs:

Full EKG Index