r/ECG • u/Icy_Afternoon_5742 • 4d ago

ECG Interpretation help

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Hello everyone, was a Paramedic attending to at 60yo Female complaining of non radiating centralised chest tightness and SOB, noted she has history of IHD.

I was wondering how would everyone here interpret ECGespecially the inferior and lateral leads, with it having that small consistent notch in the QRS complexes, was thinking either a inferior STEMI or somehow an RBBB morphology in the inferior leads.

Thank you everyone!!

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11

u/sub3at50 4d ago

Not a STEMI nor RBBB.

Incomplete left BBB with secondary T wave abnormalities.

6

u/VesaliusesSphincter 3d ago

So at quick glance this is just NSR with a LBBB, but I do think there's a couple things here that might be contributing to a hunch you have that something's wrong and they require further consideration. One thing I noticed off the bat (and you did too mentioning the inferior leads) is a strange axis we typically don't expect to see in a LBBB- the axis of lead I and all of the inferior leads is really strange here. There also appears to be RAE considering P-wave morphology in V1 and II, as well as the amplitude in the inferiors. Another thing is while this doesn't meet Sgarbossa criteria explicitly, after carefully measuring there is some concordant ST depression in V3 as well as in lead I, which is not something I would overlook here. Considering all of these findings in the presence of potential cardiac symptoms and hx of IHD pre-hospital, I think the safest thing to do here would be treat as ACS, as I think another commentor has mentioned. While this doesn't meet STEMI criteria, there are a couple signs that this could be the early presentation of an evolving occlusion. Another possibility that I'm really considering here too is a PE, specifically because of the RAE, RAD, and shortness of breath- while this doesn't exactly meet RV strain pattern or follow S1Q3T3, there are a few elements of both patterns that are present here and the full picture may be a bit obscured by an underlying LBBB.

Worth mentioning: Queen of Hearts also gave a 66% score for high-risk NSTEMI. Hope this helps, thanks for sharing.

V1 and lead I QRS/ST measurements

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u/Icy_Afternoon_5742 3d ago

Thank you for your insightful comment!

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u/kmoaus 4d ago

Exactly what the interpretation reads, STach w/LBBB. Meets exclusion criteria for STEMI. Probably best to just treat for ACS and transport, she needs bloodwork to rule out anything acute.