ECG 142: 80-year-old male with PAD and prior DVT, now with chest pain, dyspnea, diaphoresis
Caliper Start Time: 916 ms
Caliper Time Difference: 9868 ms
Caliper End Time: 10784 ms
Total Points: /
You have selected correct answers (out of “x”) and incorrect.
This ECG was obtained in an 80-year-old male with PAD and prior DVT, now with chest pain, dyspnea, diaphoresis. The tracing shows a sinus rhythm at 89 BPM with convex upward “tombstone” ST elevation in leads II, III, aVF, and associated severe ST depression in leads V1-V4. These findings are consistent with STEMI involving the inferior and posterior walls of the LV. Also present is a NSIVD, with QRS duration = 114 (best appreciated in lead V1). Although Q waves have not yet developed inferiorly, nor have prominent R waves developed in leads V1-V3, the repolarization abnormalities are diagnostic of acute inferior and posterior MIs. Scoring for ST-T changes of acute myocardial injury is optional in this setting, and doing so would likely be given neutral credit on the Cardiology Boards. This patient was taken to urgent coronary angiography/PCI, during which an acutely occluded proximal segment of a “super-dominant” RCA with a large posterolateral artery was recanalized and stented.
Correct Answers:
- Sinus rhythm +2.
- Nonspecific intraventricular conduction disturbance (IVCD) +2.
- Inferior MI, acute or recent +4.
- Posterior MI, acute or recent +4.
- ST-T changes suggesting myocardial injury 0.
- All others -1.