ECG Problem # 4

A 50-year-old man is seen in the A & E department with severe central chest pain which has been present for 18 h.

What does this ECG show and what would you do?


ECG # 4



The ECG shows:

  • Sinus rhythm, rate 64/min
  • Normal axis
  • Q waves in leads V2–V4
  • Raised ST segments in leads V2–V4
  • Inverted T waves in leads I, VL, V2–V6

Clinical interpretation

This is a classic acute ST segment elevation anterior myocardial infarction (STEMI).

What to do

More than 18 h have elapsed since the onset of pain, so this patient is outside the conventional limit for thrombolysis or percutaneous coronary intervention (PCI). Nevertheless, if he is still in pain and still looks unwell, PCI or thrombolytic treatment should be given unless there are good reasons not to do so. In any case, he should be given pain relief and aspirin, and must be admitted to hospital for observation.


Acute anterior STEMI.

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