A young peripartum woman with Chest Pain

This is written by Brooks Walsh.https://twitter.com/BrooksWalshA 30 year-old woman was brought to the ED with chest pain.It had started just after nursing her newborn, about an hour prior, and she described it as a severe non-pleuritic “pressure” radiating to the back.She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying " I'm just an anxious person. "A CXR and a CTA for PE were normal.The ECGsAn initial ECG was obtained as the pain was rapidly resolving:Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and with reciprocal ST depression in leads I and aVL.There is also a Q-wave in III.This strongly suggestsreperfusing RCA ischemia.There is also subtle STD in V3-V5.(Inverted T in V2 is likely due to lead misplacement -- this is evidence by the inverted P-wave)A second ECG was obtained 6 hours later (pain-free):Aside from a slightly biphasic T wave in lead III, the findings from the first ECG are now resolved.This dynamic findings, especially when correlated with the patient ’s resolving symptoms, arenot“non-specific.” The biphasic T wave is consistent with recent reperfusion of an occluded coronary artery supplying the inferior region. The initial STD depression in aVL and V3-V5 (later resolved)  further supports avery recent occlusion affecting this area. Troponins, echocardiogramAn echocardiogram showed inferobasil...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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