ECG's - Things you might miss


A 52 years old man presented with central chest pain for one-hour duration. He admitted that he had on and off chest pain on exertion for the last few months.

Picture from internet


House-officer noted the ST depressions and gave S/L GTN, Aspirin 300mg, Clopidogrel 300mg, and atorvastatin 40mg stat doses. The ECG was 'vibered' to SHO and on his approval, HO started S/C enoxaparin 60mg bd.

The next morning when the ECG was shown to the consultant, his eyebrows rose!

'You should've sent me the ECG.' He said.



What would you have done if this patient came to you??

 Whenever you see an ECG of a patient coming with chest pain, your priority should be to look for the presence of any evidence of STEMI, STEMI equivalents or other ECG changes that warrant immediate intervention. This is one such ECG.

 As you can see there are ST-segment depressions in many chest leads. In such instances make it a habit to look at aVR and V1 leads. 

 According to ESC guidelines,

 The presence of ST-segment depressions of more than 1mm in 8 or more leads, coupled with ST elevations in either aVR or V1 indicates left main coronary artery disease or severe triple vessel disease. Such patients require immediate coronary angiogram/PCI.

Comments

  1. Dr ThilinaSeptember 12, 2019 at 9:27 PM

    PCI
    THROMBOLYSIS

    ReplyDelete
  2. Tharanga JothirathnaSeptember 12, 2019 at 9:57 PM

    Myocarditis or pericarditis ??

    ReplyDelete
  3. UnknownSeptember 13, 2019 at 3:19 PM

    aVR ST elevation with wide spread ST depressions.this indicates LMCA critical stenosis.PCI should be offered

    ReplyDelete

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