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Quick Case #03

August 10, 2013 By Christopher Partyka Leave a Comment

the case.

42 year old female presents to ED with a 4-5 day history of central chest tightness. She has poorly controlled type 2-diabetes.

This is her ECG…

Chest Pain 4 days

How do you interpret this ECG ?

    • Rate – 62 / min
    • Rhythm – regular. Sinus.
    • Axis – leftward.
    • PR – 360msec , QRS ~ 200msec, QTc ~ 530msec.
    • Segments.
        • ST elevation; ~3-4mm (V2-3, V6), ~5mm (V4-5), ~2mm (I, aVL).
    • Extras.
        • RBBB pattern w/ LAFB.
        • Poor R-wave progression.
        • Development of T-wave inversion V2-5
        • Q-waves (V1-3)

Interpretation.

Extensive anterolateral STEMI (evolving). Associated interventricular conduction delay.

Where is the lesion ?

A 100% lesion of LAD origin was found at angiography. It was successfully stented.

What complications do we need to consider ??

  • Dysrhythmias
  • Cardiogenic shock
  • LV aneurysm
  • Free wall or septal rupture
  • Mitral regurgitation / papillary muscle rupture
  • Embolic stroke (?mural thrombus)

References.

  1. Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
  2. Rosenʼs Emergency Medicine. Concepts and Clinical Approach. 7th Edition.

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Filed Under: Cardiology, ECG Tagged With: 100% LAD lesion, AMI, anterolateral STEMI, Left anterior descending, myocardial infarction, ST elevation, STEMI

About Christopher Partyka

Emergency Doc; interested in ultrasound, retrieval & medical education - #FOAMed

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