March 2010 EKG Case

 A 48 year old female presents with chest pressure and diaphoresis for 1 hour.

What does the EKG show? And what is your diagnosis?

Rate:                                  50

Rhythm:  sinus bradycardia with PVC’s in ventricular bigeminy

Axis:    right axis

PR:    normal

QRS:   PVC’s in bigeminy

ST: ST elevation inferiorly with ST depression in V1-V6 and I, AVL

EKG Diagnosis: Sinus bradycardia with ventricular bigeminy and inferior wall ST elevations

Clinical Diagnosis:  Acute inferior wall MI

What phenomenon should you be concerned about with this EKG?

• R on T phenomenon which can degenerate into malignant ventricular dysrhythmias
• This is not a posterior MI as there are no prominent tall R waves in V1 V2. and therefore the ST depression here is a reciprocal change of the inferior MI.

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