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…
- Rate – 62 / min
- Rhythm – regular. Sinus.
- Axis – leftward.
- PR – 360msec , QRS ~ 200msec, QTc ~ 530msec.
- ST elevation; ~3-4mm (V2-3, V6), ~5mm (V4-5), ~2mm (I, aVL).
- RBBB pattern w/ LAFB.
- Poor R-wave progression.
- Development of T-wave inversion V2-5
- Q-waves (V1-3)
Extensive anterolateral STEMI (evolving). Associated interventricular conduction delay.
A 100% lesion of LAD origin was found at angiography. It was successfully stented.
- Cardiogenic shock
- LV aneurysm
- Free wall or septal rupture
- Mitral regurgitation / papillary muscle rupture
- Embolic stroke (?mural thrombus)
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
- Rosenʼs Emergency Medicine. Concepts and Clinical Approach. 7th Edition.