ECG: A Challenging Inferior MI ECG due to Interference

54 years old gentleman who is a smoker and co morbid of diabetes mellitus and hyerlipidaemia presented with left sided chest pain that radiate to the back. It is compressive in nature with pain score 10/10. Pain is associated with diaphoresis and nausea.

On examination, patient is conscious and alert, anxious and restless and in severe pain. he otherwise pink, good hydration and perfusion status, good pulse volume. No murmurs, no basal crepitation or tender hepatomegally.

ECG was obtained and full of interference as patient in pain. Left sided ECG shows sinus rhythm with Right bundle branch block, ST elevation at lead II,III, AVF and AVR. No reciprocal changes.

Right sided ECG shows no right wall involvement.

A diagnosis of Left main coronary artery stenosis with acute inferior MI was made.

Pain management is achieved with frequent small bolus of IV Morphine and patient was given IV streptokinase 1.5 Mu/ 1 hour.

Repeated ECG post streptokinase shows return of ST Elevation to the baseline