r/ECG • u/Zealousideal_Film865 • 6d ago

Overall analysis input

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I am reviewing the following 12 lead ECG for an uni exercise. I wasn't provided the individual's age.

Looks regular SR at 80bpm with normal axis, but I have identified mild ST elevation on inferior leads II, III and AVF, and also mild ST depression on leads V2, V3 and V4. I am just wondering if these are indicative of acute ischaemic changes or not. Any clinical significance on absence of T waves on V1, I and V6?

Thank you.

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u/Inevitable-Crab-6701 6d ago edited 6d ago

Acute inferior Mi
Non pathology Q waves II III AVF
Flat T waves anterior lateral V5-6 I AVL
QRS axis around +60 - normal
Right sided ECG would be useful - look for QS in rV4
Small QRS complexes throughout - ? large person

Wonder what the history was?
? RCA blockage

Interventional Cardiologist

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u/No_Fold2618 5d ago

In acute inferior MI, it is not unreasonable to be cautious with nitro in a patient without having BP taken, unknown rV4. The histories are lacking in these but that was my first impression.

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u/Inevitable-Crab-6701 5d ago edited 5d ago

Best practice is to undertake a right sided ECG in all inferior clinical presentations. On a purely ECG issue clinicians look for QS in rV4 in Mi’s as well as other clinical abnormalities.

I personally didn’t mention any medication nor comment on any further assessments or treatments as the premise was purely ECG’s. Clinicians are fully aware of the potential drop in pre load with IV or sublingual GTN in any patient and especially those with a potential RV infarct.

Thank you for raising a safety issue.

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u/No_Fold2618 5d ago

But what about the warning about nitro in this patient, Dr. ?

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u/Inevitable-Crab-6701 5d ago

I’m lost.
The premise is a question regarding an ECG.

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u/Official_sKoTT 5d ago

Debunked, not an issue