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- 84 bpm
- Sinus arrhythmia
- PR - Normal (~140ms)
- QRS - Normal (100ms)
- QT - 360ms (QTc Bazette 425 ms)
- ST Elevation leads II, III, aVF (1-2mm)
- ST Depression leads I, aVL, V1-3
- Dominant R waves lead V1-3
- Prominent T waves leads V2-3
- Inferior ST elevation with posterior involvement
What happened ?
The patient was taken for urgent angio which showed a isolated spontaneous dissection of OM1 ! The lesion was not stented and the patient had institution of medical therapy and anti-coagulation.
Subsequent echo showed normal valves and right ventricular functions with left ventricular mild-moderate infero-lateral-apical akinesia with an EF of 52%. The patients initial troponin T was 37.4 ug/L.
Spontaneous Coronary Artery Dissection
There is a nice review article on Spontaneous Coronary Artery Dissection (SCAD) by Tanis et al here:
W Tanis, PR Stella, JH Kirkels, AH Pijlman, RHJ Peters, FH de Man. Spontaneous coronary artery dissection: current insights and therapy. Neth Heart J. 2008 Oct; 16(10): 344–349. Full text here.
The highlights are following:
- This is a very rare phenomenon found at ~0.1% of all angios
- Affects young people with a mean age of 35-40 years
- Major predominance for females accounting for 70% of cases
- Aetiology not fully understood
- Associations with peripartum, trauma, and connective tissue diseases
- Can occur in the setting of atherosclerotic disease and no cause may be found
- Higher risk of complications with PCI so the majority are treated with medical management
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.