The ECG was recorded from a 60 year old man attending an agricultural show who announced to a friend that he “felt sick” and then collapsed. Fortunately, these events were also witnessed and basic life support was started by members of the public. The continued BLS until an AED arrived from the the first aid tent. He was prompdy defibrillated with initial return of a perfusing rhythm and a blood pressure of 150/60. Following the achievement of ROSC the patient regained consciousness. He was given aspirin and transferred urgently to the local cath lab for PCI where a lesion in the left anterior descending artery was stented.
The ECG shows extensive ST elevation in leads I, aVL and V2 – V6. There is reciprocal ST depression in leads 11, III and aVF. At this time there are no pathological Q waves. The pattern of R wave progression is abnormal – the R wave in V3 is smaller than the R waves in both adjacent leads (V2 and V4) suggesting infarction at some time but it is impossible from this record alone to be sure whether this is recent or the result of previous ischaemic damage.
Sudden death is a common presentation of acute myocardial infarction and occurs most commonly at the onset of symptoms or shortly afterwards. Many victims have not suffered extensive myocardial damage but die because of an arrhythmia, typically ventricular frbrillation/tachycardia. Provided basic life support and deflbrillation are carried out promptly an appreciable number of victims will survive. He survived to hospital discharge after an extensive stay. Sadly, on discharge he had a significant reduction in his ejection fraction on ECHO.