|CURRICULUM IN CARDIOLOGY - IMAGES
|Year : 2016 | Volume
| Issue : 1 | Page : 55-57
Neeraj Parakh, Sandeep Singh
Department of Cardiology, AIIMS, New Delhi, India
|Date of Web Publication||26-May-2016|
Department of Cardiology, AIIMS, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Parakh N, Singh S. Quiz (Electrocardiogram). J Pract Cardiovasc Sci 2016;2:55-7
| Question|| |
Interpret this ECG in a patient with severe chest pain.
| Case Presentation|| |
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].
| Answer|| |
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.
Left main coronary artery disease can present as a widespread ST segment depression, but ST segment elevation in aVR is a less recognized finding.
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.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Nikus KC, Eskola MJ. Electrocardiogram patterns in acute left main coronary artery occlusion. J Electrocardiol 2008;41:626-9.
Kossaify A. ST segment elevation in aVR: Clinical significance in acute coronary syndrome. Clin Med Insights Case Rep 2013;6:41-5.
[Figure 1], [Figure 2], [Figure 3]