Case A14. Acute Anterolateral Ischaemia. St Emlyn’s ECG Library.

stemlyns, ECG Library, #FOAMed, St. Emlyn’s ECG Library. http://www.stemlynsblog.org/ecg-library/History

The ECG was recorded from a 54 year old man who had undergone coronary angioplasty to the left anterior
descending coronary artery six months previously. He had experienced angina after an inferior infarct eight months previously and an exercise test had shown anterior ischaemic changes at an early stage of the exercise protocol. His angina had recently recurred and this ECG was recorded after an attack of unprovoked cardiac pain lasting half an hour had precipitated his admission to the emergency department.

ECG

The most striking finding is the presence of downsloping or depressed ST segments in the anterolateral leads I, II aVL and V3 – V6. These changes are mirrored by ST elevation in aVR which records the intracavity ECG. There are pathological Q waves in leads III and aVF from the previous infarction.

Comment

Previous ECGs were available for comparison and the changes were shown to be a new development and fortunately resolved without ECG further ECG changes or significant rise in hsTroponin. The ST/T changes seen here are very different to those in the previous examples recorded in the early stages of infarction. The appearances of the ST/T waves are not absolutely diagnostic of ischaemia and a similar appearances could be recorded in left ventricular hypertrophy, conduction disturbance or in patients taking digoxin. However in this case none of these factors apply and the patient is known to have transient and developed acutely after an attack of ischaemic chest pain; they provide valuable diagnostic evidence of myocardial ischaemia in this case.

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