Instructions
You are a medical student on placement with an emergency telehealth service in Perth. A nurse at a mine-site clinic in the Pilbara, more than 1,000 km north of Perth, has called you on video about Minh Le, 52, a fly-in fly-out fitter with 40 minutes of crushing central chest pain. His ECG is below.
Interpret the ECG provided
Outline to the examiner:
- Your most likely diagnosis
- Next steps in management
- The examiner plays the site nurse, who will answer your questions and carry out your instructions
- You do not need to take a full history or examine the patient
12-lead ECG recorded at the clinic
| Item | Value | Reference range |
|---|---|---|
| Rate | 96 /min | 60-100 /min |
| Rhythm | Regular; an upright P wave before every QRS | Sinus |
| Axis | +45 degrees | -30 to +90 degrees |
| P waves | Normal morphology | Normal |
| PR interval | 160 ms | 120-200 ms |
| QRS duration and morphology | 90 ms, narrow; small r waves in V1 to V3; no Q waves | <120 ms |
| ST segments | Raised and convex upwards: 2 mm in V1, 4 mm in V2 and V3, 3 mm in V4, 2 mm in V5. Depressed 1.5 mm in III and aVF and 1 mm in II. At the baseline in I, aVL and V6 | Isoelectric |
| T waves | Tall and broad in V2 to V4; inverted in III | Upright in I, II and V3-V6 |
| QTc | 430 ms | <450 ms |