Intermittent exertional chest pain over the preceding week .
Continuous chest pain for the last hour with dysponea and diaphoresis.
Past history of hypertension. Non smoker with no family history.
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- Sinus rhythm
- LAD (-35 deg)
- PR - Normal (~140ms)
- QRS - Normal (100ms)
- QT - 380ms (QTc Bazette ~ 430 ms)
- ST Elevation leads aVR (1mm) V1 (2mm), V2 (4mm), V3 (3mm), V4 (2mm)
- ST Depression leads I, II, V6
- Small q wave leads aVL, V2, V3
- Prominent 'hyperacute' Twaves leads V1-4
- Acute Anterior STEMI
The patient was transferred for immediate PCI which showed:
- Mid-LAD 100% Occlusion --> Stented
- All other vessels normal
- Apical akinesis on ventriculogram
The patient was discharged following a 3 day in-patient stay.
References / Further Reading
Life in the Fast Lane
- Anterior STEMI here
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.