ECG Challenge Response ECG Response: May 20, 2014 ECG Challenge: A 66-year-old man with a history of hypertension and hyperlipidemia presents with substernal chest burning that he felt was gastrointestinal related because it occurred shortly after lunch. However, antacids were without benefit. After 4 to 5 hours, he decided to go to an emergency room. On the basis of ECG abnormalities and elevated serum troponin and creatine kinaseMB, he was brought to the cardiac catheterization laboratory. One-vessel disease (right coronary artery) was noted, and a percutaneous coronary intervention was performed.
There is a regular rhythm at a rate of 50 bpm. There is a P wave before each QRS complex (+) with a stable but short PR interval (0.12 second). The P waves are abnormal in that they are negative in leads II, aVF, and V3 through V6. Hence, the rhythm is not a sinus but an atrial rhythm. There is ST-segment elevation in leads II, III, and aVF (▼). In addition, there are T-wave inversions in these leads (▲). The ECG shows an acute inferior wall ST-segment–elevation myocardial infarction. Along with this, there are ST-segment depressions in leads I and aVL (^), which are reciprocal changes seen with an acute ST-segment elevation inferior wall myocardial infarction. Also noted is ST-segment elevation in leads V1 and V2 (↓). When associated with an acute inferior wall
Correspondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Pkwy, West Roxbury, MA 02132. E-mail [email protected] (Circulation. 2014;129:2078-2079.) © 2014 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.010615
2078
ECG Challenge Response 2079 myocardial infarction, these ST-segment elevations are consistent with infarction of the right ventricle, which is the chamber that lies below leads V1 and V2. Obtaining right-sided leads would be further confirmation of involvement of the right ventricle. The presence of ST-segment elevation in right-sided V3 and V4 is seen when there is infarction of the right ventricular free wall. Although the ST segment elevation in leads V1-V2 is suggestive an an acute anteroseptal infarction, the localization of ST segment changes in only V1-V2 and not other precordial leads is unusual. In addition the reciprocal changes in leads I and aVL are consistent with an inferior wall infarction as the primary area of involvement. Having both an acute inferior and anteroseptal myocardial infarction would be rare. The QT/QTc intervals are normal (400/365 milliseconds). Please go to the journal’s Facebook page for more ECG Challenges: http://goo.gl/cm4K7. Challenges are posted on Tuesdays and Responses on Wednesdays.
Copyright of Circulation is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
There is a regular rhythm at a rate of 50 bpm. There is a P wave before each QRS complex (+) with a stable but short PR interval (0.12 second). The P waves are abnormal in that they are negative in leads II, aVF, and V3 through V6. Hence, the rhythm is not a sinus but an atrial rhythm. There is ST-segment elevation in leads II, III, and aVF (▼). In addition, there are T-wave inversions in these leads (▲). The ECG shows an acute inferior wall ST-segment–elevation myocardial infarction. Along with this, there are ST-segment depressions in leads I and aVL (^), which are reciprocal changes seen with an acute ST-segment elevation inferior wall myocardial infarction. Also noted is ST-segment elevation in leads V1 and V2 (↓). When associated with an acute inferior wall
Correspondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Pkwy, West Roxbury, MA 02132. E-mail [email protected] (Circulation. 2014;129:2078-2079.) © 2014 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.010615
2078
ECG Challenge Response 2079 myocardial infarction, these ST-segment elevations are consistent with infarction of the right ventricle, which is the chamber that lies below leads V1 and V2. Obtaining right-sided leads would be further confirmation of involvement of the right ventricle. The presence of ST-segment elevation in right-sided V3 and V4 is seen when there is infarction of the right ventricular free wall. Although the ST segment elevation in leads V1-V2 is suggestive an an acute anteroseptal infarction, the localization of ST segment changes in only V1-V2 and not other precordial leads is unusual. In addition the reciprocal changes in leads I and aVL are consistent with an inferior wall infarction as the primary area of involvement. Having both an acute inferior and anteroseptal myocardial infarction would be rare. The QT/QTc intervals are normal (400/365 milliseconds). Please go to the journal’s Facebook page for more ECG Challenges: http://goo.gl/cm4K7. Challenges are posted on Tuesdays and Responses on Wednesdays.
Copyright of Circulation is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
