Quick Case #06

the case.

76 year old male presents to ED with 2 hours of retrosternal chest pain. He is clammy, diaphoretic & looks miserable.

He has a past history of ischaemic heart disease “with a stent” & reports stopping his clopidogrel a week ago to facilitate a gastroscopy/colonoscopy.

This is his ECG…


[DDET Describe & interpret his ECG…]

  • Rate.
    • ~ 84 bpm.
  • Rhythm.
    • Regular → sinus.
  • Axis.
    • -50* [therefore, LAD]
  • Intervals.
    • PR ~ 120 msec
    • QRS ~ 140 msec
    • QTc ~ 440 msec
  • Segments.
    • ST elevation: V2-6 + I & aVL. [Max 3mm, V3].
    • ST depression: II, III & aVF [~3mm].
  • Others.
    • RBBB pattern
    • Atrial ectopics (Beats 6 & 8) ?compensatory pauses.


Acute anterolateral STEMI with right bundle branch block & reciprocal inferior ST depression

This patient meets reperfusion criteria (thrombolysis or PCI).


[DDET Recall the complications that frequently follow this type of infarct…]

Refer to Quick Case #03


[DDET The outcome…]

Our cardiology team obligingly take our patient to the Cath lab…

Angiography report.

  • 100%  LAD (origin) lesion
  • Previous drug-eluted stent (LAD).
    • Late stent thrombosis (post clopidogrel withdrawal)
    • Thrombectomy performed…

…it was here they plucked this from his LAD !!

LAD clot
Stent thrombosis



[DDET End note]

This was truly a ‘quick case’ with no secrets and tricks.

I saw it mainly as an opportunity to share another great ECG & a rare opportunity of ‘therapeutic followup’ – ie. the clot in the bucket photo !!

Hope it was helpful….


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