EKG of the Week 2019 4-7

This EKG comes courtesy of Dr. Tony Gao.

A 68 year old male presents complaining of chest pain and SOB x 2 hour. Described as pressure-like. Non-radiating. Began with mild exertion.  Has been persistent since.

Vital signs: Pulse – 65, Respirations – 18, BP 140/90.

His EKG is below.

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1.      What does the EKG demonstrate?

2.      How would you manage this patient?

ANSWER:

The EKG shows ST elevation in lead I and aVL consistent with a lateral wall MI.

The patient should be managed as a STEMI with antiplatelet therapy and urgent revascularization.

 

 

The EKG shows ST elevations in lead I and aVL as well as 0.5 mm ST elevations in leads V5 and V6. There are reciprocal depressions in lead III.

 

ST elevations represent acute injury to the myocardium. Leads II, III and aVF look at the inferior wall. Leads V1 and V2 look at the interventricular septum. Leads V3 and V4 look at the anterior wall. Leads V5, V6, I and aVL look at the lateral wall.

 

The most common location of a STEMI is in the inferior wall. Next is the anterior wall and the least common location is the lateral wall. Lateral wall ST elevations are often more subtle than in other walls of the heart.

 

Our patient went to the cath lab and was found to have a 100% occlusion of the left circumflex artery. He had a successful PCI and did well.