Friday, 15 May 2015

ECG of the Week - 11th May 2015 - Interpretation

This ECG is from a 35yr old female who presented to the Emergency Department complaining of right sided sharp chest pain for the last 7 hours. Vital signs are all within normal limits. She has no relevant past medical or family history.
Check out the comments on our original post here.

Click to enlarge
Rate:
  • 84 bpm
Rhythm:
  • Sinus arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Normal (~140ms)
  • QRS - Normal (100ms)
  • QT - 360ms (QTc Bazette 425 ms)
Segments:

  • ST Elevation leads II, III, aVF (1-2mm)
  • ST Depression leads I, aVL, V1-3
Additional:
  • Dominant R waves lead V1-3
  • Prominent T waves leads V2-3

Interpretation:

  • 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

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.