Quick Case #03

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…

[DDET 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.

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[DDET Where is the lesion ?]

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

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[DDET 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)

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[DDET 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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