Name that ECG: 66 year old female – Findings

This is the conclusion to our Name that ECG case: 66 year old female, resolved chest pain.

66 year old female, resolved chest pain.

Name that ECG: 66 year old female

 

Rhythm:

  • Rate: atrial rate of ~55 bpm, ventricular rate of ~55 bpm
  • Regularity: regular
  • P-waves: sinus (upright in I and II), associated 1:1 with the QRS
  • PRi: 140 ms
  • QRS duration: 90 ms

Bonus points:

  • Axis: -45 degrees, left axis deviation, LAFB
  • Bundle Branches: normal conduction
  • QTc: normal (<1/2 R-R interval), 420 ms (Bazett's Formula)
  • ST/T-waves:
    • T-waves: flipped T-waves in aVL, biphasic V2-V5 consistent with Wellen's Syndrome
    • ST-elevation: none noted
    • ST-depression: none noted

Differentials:

  • Normal sinus rhythm in a patient with Wellen's Syndrome
    • Possible high-grade stenosis of the LAD with recent reperfusion

Notes:

  • Wellen's Syndrome should be regarded with the same importance as a STEMI during assessment and transport.

1 Comment

  • VinceD says:

    If you wanted to really push the limits of this ECG I also see inverted inverted U-waves in leads V2-V4, I, and aVL. They're super faint and I wasn't sure if I believed them at first, but measuring from the QRS to the U wave in III and aVF and transposing that interval to the other leads proves that it's really them.

    They don't add any information the T-waves don't tell you here, but heck, they're there.

    And now I'm really being a pain, but I think calling a LAFB is being a little generous to that LAD.  By my eye I put the axis, at most, at around -40 degrees. There's also no well developed rS complexes in II and aVF and the tracing lack the poor R-wave progression I usually see in true LAFB's. There doesn't seem to be an accepted criteria for making the Dx, but this one seems to be pushing it.

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know it all parapup
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@ Kyle I would question your authority to call out people for not having a license or being a know it all parapup when your tx basically entails "call medical control." I think we can both agree that his cardiac output is not great at all. I assume your reluctance to give him any other…
2014-10-30 20:26:11
Kyle
83 Year Old Male: Shortness of Breath
Well st elevation in avr and v1 associated with anterior and lateral depression would call for possible posterior wall MI. 15 lead would be in order. Also check all the leads for appropriate placing. If v7, v8, and v9 show the elevation i would treat as a STEMI per my protocol. Asprin only until medical…
2014-10-30 18:14:05
Tim
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Thanks for the app. It made me think about all that one may see in the field. The only problem was I never got a score or saw the results of how I did other than saying I had completed the test. Anyway a great way to get the old brain working.
2014-10-30 13:14:27
Brian
83 Year Old Male: Shortness of Breath
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2014-10-30 04:22:44
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