The following ECG is from a 57 yr old male who presented to the Emergency Department complaining of chest pain for 1 hour. He is an ex-smoker and has a history of hypertension and hypercholesterolaemia.
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- Mean ventricular rate 84 bpm
- ST Elevation leads II (1-2mm) III (3mm) aVF (2mm)
- ST Depression leads I, aVL, V2-6
- T wave inversion leads I, V3-6
- Biphasic T wave leads aVL, V2
- R/S ratio V2 >1
- Voltage criteria for LVH
- Infero-posterior STEMI
- Atrial fibrillation
What happened ?
The patient was transferred for urgent angiography which showed:
- Left main – Normal
- LAD – Normal
- Left circumflex – 70% Mid-Cx lesion –> stented
- RCA – Normal
Post angiography echo showed severe aortic stenosis, dilated left atrium, increased LV wall thickness / mass and hypokinesis to to left ventricle.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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