A 60-year-old man was seen as an outpatient, complaining of rather vague central chest pain on exertion. He had never had pain at rest.
What does this ECG show and what would you do next?
The ECG shows:
- Sinus rhythm, rate 77/min
- Normal PR interval
- Normal axis
- Prominent and deep Q waves in leads II, III and VF, indicating an inferior infarction. There are also small Q waves in leads V5–V6, but these may be septal
- ST segments normal, with no elevation in the leads showing Q waves
- Inverted T waves in leads II, III and VF
The Q waves in the inferior leads, together with inverted T waves, point to an old inferior myocardial infarction.
What to do
The patient seems to have had a myocardial infarction at some point in the past, and by implication his vague chest pain may be due to angina. Attention must be paid to risk factors (smoking, blood pressure, plasma cholesterol), and he probably needs long-term treatment with aspirin and a statin. An exercise test or a perfusion scan will be the best way of deciding whether he has coronary disease that merits angiography.