EKG of the Week
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This EKG was done on a 46 year old with 1-2 days of worsening of abdominal and chest pain, now lasting for several hours.
+ EKG Interpretation
Dr. Ohlbaum's Explanation
Of interest, he had been complaining of similar abd and chest pains intermittently for several months. About a month ago, he had an upper GI endoscopy for this showing some esophagi tis and gastritis and was treated with a PPL He had not had an EKG since 2017, at that time it was normal. Let's look at the EKG.
There are P waves, and every Pis followed by a QRS, nothing extra and nothing missing. The rate is 94 so normal sinus rhythm {albeit a bit fast for a 46 yr old lying on a bed). His P wave has a big negative component in Vl so possible left atrial enlargement. The PR interval is normal.
His QRS duration is normal, the axis is normal, and the amplitude is normal. He has Q waves in the inferior leads suggesting possible old inferior Ml. He also has small initial Q waves in the precordial leads along with significant ST elevation in V2 thru VS, and inverted Twaves in the lateral leads. What does that mean? This ST elevation is INJURY.
This is an acute, anterior STEMI. He also probably has an old {or at least not acute) inferior Ml.
What is the treatment for this?
Code STEMI and cath lab. At cath, he had severe 3 vessel disease- 20% left main, 100% prox lad felt to be the culprit lesion, 100% mid ex, 70% rca.
