Name that ECG: 66 year old female

Welcome to another installment of Name that ECG! Remember, this is a cold read and your job is to interpret the ECG to its fullest.

66 year old female, resolved chest pain.

Name that ECG: 66 year old female



  • Rate?
  • Regularity?
  • P-waves?
  • PR interval? Associated?
  • QRS width?

Bonus points:

  • Axis?
  • QTc?
  • ST/T-wave changes?

What are your differentials?

Posts which include any permutation of the phrase "treat the patient not the monitor" will be deleted and their author beaten with a LifePak 5.


  • Robert says:

    Interpretation: Sinus Brady @ 50-60 (based on upright P waves in I, II, III, avf and negative p wave in avr and hr < 60 w/ regular rhythm), Left Axis Deviation, LAFB(LAD, qr in I/AVL, rS in II, III, Avf), Biphasic T waves in V2, V3, V4 highly suggestive of Wellens Syndrome. Inverted T wave in AVL.

  • Todd says:

    Wellen's Syndrome with some left axis deviation?

  • alex says:

    About 60
    •PR interval? Associated?
    Borderline for 1st degree AVB. 1:1 association
    •QRS width?
    Normal at 0.08s
    Left (positive QRS in I, negative QRS is aVF)
    Less than half the RR interval so probably ok
    •ST/T-wave changes?
    Wellens waves in V2-V5
    TWI in I and aVL
    Which all points to partial LAD occlusion but isn't enough to activate a cath lab?

  • RyanTee says:

    Rate is about 60 bpm, regular rhythm P waves are these, PRI is good, QRS is wide with LBBB, LAD is seen..QTc is normal, Biphasic T waves seen with negative terminal – first stage of Wellens syndrome…urgent but not immediate cath…R waves are there meaning the artery is not yet infarcted…there is spontaneous reperfusion..

  • Ben W says:

    I definitely say it’s textbook wellen’s syndrome. Inversion in AvL and hyper acute-ish looking T waves inferiorly kinda makes me think Type III wraparound LAD occlusion due to possible inferior injury with the more obvious anterior injury. Happy holidays kids!

  • @Ryan Tee – I'm not seeing any evidence of left bundle-branch block (LBBB).  In fact, if LBBB was actually present, then it would probably mask the ST-T changes of "Wellens' warning".  The duration of the QRS interval is normally narrow at 0.08s and there are triphasic "qRs" complexes in both lead I and V6. 

  • Andrew Przepioski says:

    Rhythm: Sinus bradycardia
    Rate? 56
    Regularity? Yes.
    P-waves? Yes.
    PR interval? Associated? 0.16s. Yes.
    QRS width? 0.08s.
    Bonus points:
    Axis? QRS -30 degree. Z +40.
    QTc? 425 ms.
    ST/T-wave changes? Biphasic T-waves V1-V5. Retrograde in aVL.
    What are your differentials? LAD occulsion. I have nothing else to add to my DDx.
    56, sinus bradycardia, LAFB, LAE, anteroseptal ischemia.
    Rate: 56
    Rhythm: Regular, p-waves present, P:QRS 1:1, PRi about 0.16s, QRS narrow 0.08s. Sinus bradycardia.
    Axis: QRS – I +, avF -, II -, -30 degree, LAD, LAFB (qR in I, rS in III too).
    Z V4 +40m, V1-V3 looks like the leads were placed 1 ICS too high (V3 r-wave >3 mm).
    Enlargement/Hypertrophy: Left atrial enlargement (2nd 1/2 of P-wave in V1 >0.04s, 1mm deep)
    ST/T, Q: insignificant q-waves in I and aVL. Significant Q in II and aVF. III has a small r-wave. No significant STE, but V1-V5 has retrograde T-waves. V2-V3, are those Wellen's T-waves? aVL also has a retrograde T-wave.
    QT 440 ms.
    QTc 425 ms.
    I'd be concerned about LAD occulusion cause of the T-waves in the anteroseptal leads.

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

“Bad heartburn” – 82 y.o. female without chest pain.
I would do a v4r to see if right side involvement as well as posterior v8-v9. Based on the pt not presenting hypotensive this can be RCA occlusion caused by disection of thoracic aortic aneurysm! Debakey type 1 aneurysm! No catch lab however surgical intervention would be required!
2015-10-01 16:47:29
“Bad heartburn” – 82 y.o. female without chest pain.
It's most likely a RVMI because the ischemia/infarction has effected the SA node. IWMI with bradycardia should highly suspect a RVMI. Not all RVMI's are preload dependant. Do a 15 lead ecg to verify V4R elevation. Have 2 IV's established with a bolus of at least 1L of fluid before giving nitrates. If the pt…
2015-10-01 08:55:01
“Bad heartburn” – 82 y.o. female without chest pain.
I kept feading this thread to see how long it'd take for someone to call it as it is 'inferioposterior MI' and the prize goes to iliyas on Sept 11.
2015-10-01 04:08:23
Kevin Dittrich
“Bad heartburn” – 82 y.o. female without chest pain.
S-T (J-Point) elevation in II, III, and AVF are clear. There are no repol abnormalities. There are even reciprocal changes. IV with fluids is a must but beyond that, what else is there. Females, especially, present with atypical symptomologies. Be ready with fluids, but treat with standard AMI protocols. Presentation, ECG, age, sex, it's not…
2015-09-30 13:37:09
“You Make the Call” — 86 Year old Female: Dizzy
There is no LBBB as QRS <120ms. Diagnosing LAHB in a patient with LVH is difficult. ST elevation is appropriate for LVH. 1st degree HB rarely causes symptoms, but when combined with a betablocker could be problematic. I'd want her to have 24 hours telemetry monitoring to rule out cardiac causes of dizziness.
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