My life time clinical coronary skill went in vain . . . when this patient entered my clinic with chest pain !

Evening cardiac clinic is generally a relaxing place until an occasional patient  with vague chest discomfort present with this sort of an ECG . He was a 68 y old hypertensive and was on Tablet Amlodipine .After a cursory look at his ECG , eyes wandered to look for some specifics. Suddenly ,my  ECG reading skill was stretched . Is it really LVH ? or Ischemia ? I asked for any old ECG which he couldn’t provide. I had to blink  more than a moment , before asking him to describe his chest pain in detail one more time . I got almost convinced it was not ACS  since he was having only localized pain over left side of chest. Still , I didn’t have the courage to send him home. An Echo was done. Curious to know what the Echo showed ?   Yes , you also probably guessed right . It is LVH and there is no wall motion defect either. How to differentiate between Ischemia and LVH ? This is a common question asked in the board exams.There are number of ECG clues to differentiate the two .Mostly it will help  fellows  to pass exams. Academics rarely comes to your rescue when patients land with  chest pain  especially at odd hours. Find the answer in this link https://drsvenkatesan.com/2009/12/12/how-to-differentiate-lv-strain-pattern-from-primary-lv-ischemia/   Now comes the real twister , Does presence of LVH  exclude Ischemia in any way ? Why can’t be ACS in a patient with LVH ? When I posed these questions , some one suggested global longitudinal ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: acute coroanry syndrome acute coronary syndrome Clinical cardiology lvh vs ischemia primary vs secondary st t changes triaging chest pain Source Type: blogs