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…

Chest Pain 4 days

[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)


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


[DDET Where is the lesion ?]

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


[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)


[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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