EKG November

You know what to do, best answers below — get out of call free card this month!

4 Responses

  1. Faysal

    The EKG shows sinus tachycardia, there is significant ST sigment elevation in leads aVr and V1 (aVr>V1), with resprocal ST depression in leads i and aVL, all of these changes are concerning for significant coronary disease like Left main or 3 vessel dissease.

  2. Nagarjuna R Gujjula

    My interpretation:
    – Sinus Tachycardia (Approx 120 Bpm)
    – interventricular conduction delay with QRS prolongation ( 120 m sec)
    – wide spread upsloping ST depressions and horizontal ST depressions
    – ST elevations in aVR and V1/V2

    These findings are concerning for proximal LAD obstruction specially given patient’s age and history of DM puts him at high risk for diffuse atherosclerosis.

  3. Luay Sarsam

    – Sinus Tachycardia
    – ST segment elevation in AVR/V1 with reciprocal changes in all other leads.
    – This ST elevation with AVR > V1, suggesting left main coronary artery (LMCA) Disease. Other possibilities are: diffuse coronary artery disease (3 Vessel Disease), Proximal left anterior descending artery (LAD) occlusion, or secondary to prolonged hypotension, or Diffuse subendocardial ischemia (O2 supply/demand mismatch) as in following resuscitation from cardiac arrest.
    – Poor R wave progression,
    – Possible Left atrial enlargement,

  4. Dr. Smer

    Excellent interpretation everyone…! While Faysal cut to the chase, Arun and Luay dissected the EKG to every single detail. This EKG is classic for global ischemia (LM or 3 V dz), not proximal LAD. Proximal LAD usually gives deep anterior T wave inversion (Wellens Syndrome). I’m glad that all of you mentioned the sinus tachycardia, which indicates that the patient’s heart trying to compensate for ischemia by increasing heart rate. How many patients with chest pain and ACS have you seen and has sinus tachycardia, not many…! The point I’m trying to make is that sinus tachycardia is a hint that something serious is going on…! In regard to ST-T changes, there is diffuse ST-depression, usually > 6 leads accompanied with ST elevation in aVR and V1 and as Faysal pointed out the ST elevation in aVR is more prominent than V1), these findings are typical for global ischemia which is due to critical left main disease or 3 vessels coronary disease.
    Interestingly, we have admitted a patient over this weekend with totally occluded left main and has almost the same EKG changes, I’ll send it to Dr. Abu Hazeem and Osman to share with you.

    Good job everyone

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