Chest pain with anterior ST depression: look what happens if you use posterior leads.
Don ' t forget to watch theWebinar: Smith and Pendell Meyers interpret ECGs for OMI or not OMI on Monday Feb 12 at 11 AM U.S. Central time. Register here:https://zoom.us/webinar/register/7617067094184/WN_LMN0vPb1Rz-HZu12K-QuYQWritten by Jesse McLarenA 65 year old
with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented
with 3 days of fluctuating chest pain, which was ongoing at triage. What do you
think? Do you need posterior leads?There ’s atrial
flutter with controlled ventricular response, a non-specific intra-ventricular
conduction delay, borderline right axis, normal R wave progression and normal
voltages. The abnormal depolarization from the IVCD can produce secondary repolarization abnormalities, but here there appears to b e superimposed primary ST depression V2-4 indicating posterior OMI. Here ' s the prior ECG:This confirms thew anterior ST depression is new.The first ECG was
labeled “anterior subendocardial ischemia”, but subendocardial ischemia does
not localize. If there were diffuse ischemic STD, with precordial STDmaxV5-6
and reciprocal STE-aVR, this would be non-specific subendocardial ischemia from
ACS or supply-demand mismatch.But here there is ischemic STDmaxV1-4, which is not “anterior subendocardial ischemia” but rather reciprocal to posterior OMI. So a patient
with high pretest probability (prior CABG with new chest pain), had new ECG
changes showing posterior OMI. Do you need posterior leads...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Jesse McLaren Source Type: blogs
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