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 Table of Contents  
Year : 2016  |  Volume : 2  |  Issue : 1  |  Page : 55-57

Quiz (Electrocardiogram)

Department of Cardiology, AIIMS, New Delhi, India

Date of Web Publication26-May-2016

Correspondence Address:
Neeraj Parakh
Department of Cardiology, AIIMS, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-5414.182994

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How to cite this article:
Parakh N, Singh S. Quiz (Electrocardiogram). J Pract Cardiovasc Sci 2016;2:55-7

How to cite this URL:
Parakh N, Singh S. Quiz (Electrocardiogram). J Pract Cardiovasc Sci [serial online] 2016 [cited 2023 Feb 2];2:55-7. Available from: https://www.j-pcs.org/text.asp?2016/2/1/55/182994

  Question Top

Interpret this ECG in a patient with severe chest pain.

  Case Presentation Top

A 48-year-old gentleman presented with an acute onset chest pain of 3 h duration. On clinical examination, his pulse rate was 96/min, blood pressure - 80/50 mmHg, and crepts were noted up to mid-thorax on chest auscultation. Electrocardiogram as shown in [Figure 1].
Figure 1: Electrocardiogram: At presentation.

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  Answer Top

Electrocardiogram revealed anterior wall ST elevation myocardial infarction. ST elevation of 1 mm in lead aVR along with ST depression in lead V1 (aVR > V1) and diffuse ST depression (lead II, III, aVF, V1, and V6) was suggestive of acute left main coronary artery occlusion [Figure 1].

Left main occlusion should be suspected in patients with widespread ST-segment depressions, especially in leads V4–V6 with inverted T waves or ST elevation involving the anterior precordial leads and the lateral extremity leads I and aVL. In addition, lead aVR ST elevation accompanied by either anterior ST elevation or widespread ST-segment depression may indicate left main occlusion.[1]

Left main coronary artery disease can present as a widespread ST segment depression, but ST segment elevation in aVR is a less recognized finding.[2]

His coronary angiogram revealed complete occlusion of the left main coronary artery [Figure 2] and normal right coronary artery. He underwent successful angioplasty and stenting of left main coronary artery with intra-aortic balloon pump support [Figure 3]. He developed multiple episodes of ventricular tachycardia, which were successfully treated with DC cardioversion and antiarrhythmic drugs. He died of progressive heart failure and cardiogenic shock after 2 days.
Figure 2: First angiogram.

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Figure 3: Angiogram after intervention.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Nikus KC, Eskola MJ. Electrocardiogram patterns in acute left main coronary artery occlusion. J Electrocardiol 2008;41:626-9.  Back to cited text no. 1
Kossaify A. ST segment elevation in aVR: Clinical significance in acute coronary syndrome. Clin Med Insights Case Rep 2013;6:41-5.  Back to cited text no. 2


  [Figure 1], [Figure 2], [Figure 3]


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