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Yet another one!


I would like to share with you this case I saw in Nashville a couple of days ago..

A 47-year-old Hispanic lady, presented to the Emergency department (ED) with chest pain while climbing the stairs. The pain lasted for 45 min before arrival to ED.

Her presenting EKG is shown here.

What is the interpretation of the EKG, and what we do next?

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Replies (6)
    • Cardic enzymes if normal stress ECG!

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      • Dr. @Fatma what do think of the EKG? How abnormal is it?

        • In the ED the first EKG showed ST segment elevation in leads 1 and AVL and lead 2 and ST segment depression in lead 3 (the one above). Initial high-sensitivity troponin was 20 (range 0-12).

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        • ST elevation in lead I and AVL with ST depression in Lead III V5-6. Anterior MI. Proximal LAD or LCX usually the occluded vessel.

          Details history for previous episode and Risk factor DM, HTN.. etc

          Serial ECG and cardiac enzymes.

          Blood pressure measurement and support.

          Antiplatelets + Anticoagulation

          Pain control

          Urgent Cardiology consultation with high possiblity of urgent C. Angio PCI.

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          • Thank you for the explanation. First EKG shown had st segment elevation in leads 1, Avl and v2 and St segment depression in lead 3 ( South African flag sign) check link for explanation.

            On repeat EKG patient had the ECG below.

            Most likely diagnosis?

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            • Her cardiac angiography showed patent vessels with exception of sudden tapering of the first diagonal branch (image below) which, in the clinical context and EKG and troponin changes, was very suspicious of SCAD (spontaneous coronary artery dissection).

              The patient was treated conservatively and did well.

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