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- Sinus Rhythm
- Normal (-33 deg)
- PR - Normal (~160ms)
- QRS - Normal (100ms)
- QT - 380ms (QTc Bazette 380-400 ms)
- Subtle ST depression leads V4-6
- Deep T wave inversion lead III
- Biphasic T wave lead aVF
- Prominent T waves leads I, aVL (of equal or greater height than QRS)
- Very suspicous ECG for ACS
What happened ?
The patient had serial ECG's which showed dynamic T wave changes in the inferior leads and T wave amplitude antero-laterally. Serial troponins were positive.
The patient underwent angiography which showed:
- LMCA: Minor irregularities
- LAD: Mid 99% single discrete lesion
- Ostial 1st Diagonal: 90% single discrete lesion
- CX: Irregularities
- RCA: Irregularities
The patient was commenced on dual anti-platelet therapy (DAPT), statin, ACE and beta-blocker therapy.
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.