ECG of the Week: ECG of the Week - 11th May 2015

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.

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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