This 31-year-old man presented to the Emergency Dept. complaining of chest pain, shortness of breath, and nausea. His heart rate on admission was 120 - 130 bpm and irregular, and the monitor showed atrial fibrillation. His rate slowed with the administration of diltiazem. His 12-lead ECG shows the classic ST elevation of inferior wall M.I. in Leads II, III, and aVF.
Right ventricular M.I.
This series of ECGs was taken during ambulance transport of a 67 year old man with chest pain. Earlier the same week, this man had been discharged from the hospital after having a cardiac cath, angioplasty, and stents. He was discharged the next day. The patient stated that, until that hospital admission, he was healthy, athletic, and had no significant medical history. He is currently taking a statin, atenolol, and "one of the new blood thinners" - he didn't know the name.
This week's ECG of the Week is from an elderly woman who suffered an acute occlusion of the right coronary artery. The ECG clearly shows ST elevation in leads II, III, and aVF, indicating inferior wall injury. In this case, this ECG was obtained in the field by paramedics, and was the second ECG done on this patient. For this tracing, the paramedics obtained V3 and V4 on the right side to better view the right ventricle.
These two ECGs are from a 57 year old man with chest pain. The initial ECG shows ST elevation in Leads II, III, and aVF - inferior wall STEMI. Reciprocal changes are as expected in I and aVL. Reciprocal ST depression also seen in V1 and V2 indicate probable posterior wall involvement. Not surprising since the inferior wall is simply the lower part of the posterior wall. The first ECG also shows the patient in sinus brady with junctional escape: AV dissociation. The sinus node is often affected in IWMI that is caused by right coronary artery occlusion.
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