SUBSCRIBE for Upcoming Course Announcements
SUBSCRIBE for Upcoming Course Announcements
Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.
A 65 year old presented with 13 hours of chest pain
Based on symptoms, this is a ‘late presenting STEMI'(>12 hours), which is traditionally considered to benefit less from reperfusion because of myocardium has already been lost. But does the ECG show a subacute or acute occlusion?
H: sinus borderline tachy
E: first degree AV block
A: normal axis
R: delayed but no Q waves
T: normal voltages
S: anterolateral STE with mild terminal T wave inversion, reciprocal inferior STD
Acute anterolateral STEMI without Q waves. Cath: 100% LAD occlusion.
First hs-troponin I was only 700ng/L (correlating with the ECG rather than the symptoms), peak 130,000
Prolonged symptoms does not mean prolonged occlusion, as there can be intermittent reperfusion and reocclusion. The ECG can be a better indicator of occlusion time: from acute (no Q waves + STE + hyperacute T waves) to subacute (Q waves + shallow convex STE + T wave inversion).
