Changing Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery.

Abstract

HomeCirculationVol. 103, No. 16Changing Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBChanging Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery Dona Brekke, Curt G. DeGroff and Michael Schaffer Dona BrekkeDona Brekke From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver. Search for more papers by this author , Curt G. DeGroffCurt G. DeGroff From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver. Search for more papers by this author and Michael SchafferMichael Schaffer From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver. Search for more papers by this author Originally published24 Apr 2001https://doi.org/10.1161/01.CIR.103.16.e85Circulation. 2001;103:e85–e86A6-month-old child with clinical signs of heart failure and cardiomegaly on chest radiograph was referred for evaluation. An echocardiogram and angiogram demonstrated an anomalous left coronary artery originating from the pulmonary artery (ALCAPA). After 3 days of intensive medical management including intravenous inotropes and diuretics, significant differences were found in the ECGs on the day of admission (Figure 1) versus before surgery on day 3 after admission (Figure 2).Typical findings on the ECG for patients with ALCAPA have previously been well described. The abrupt loss of the R wave in the midprecordial leads associated with ALCAPA is not seen on the presenting ECG (Figure 1) but is seen on day3 (Figure 2). Prominent Q waves associated with ALCAPA in leads I and aVL are not present in the first ECG (Figure 1); they become prominent, however, on day 3 (Figure 2). Conversely, typical prominent Q waves in lead V6 associated with ALCAPA are evident on the first ECG (Figure 1) but not on the ECG taken on day 3 (Figure 2).Previous studies have indicated that individual patients with ALCAPA can present with any combination of the findings mentioned. Such ECG changes in the course of medical therapy, however, have not been reported. We speculate that such changes occurred as a result of decreased pulmonary pressures (confirmed by echocardiogram), encouraging a dynamic coronary steal phenomenon. Download figureDownload PowerPoint Figure 1. ECG from day 1 of presentation in patient with ALCAPA. Typical prominent Q waves are present in lead V6. Conversely, typical abrupt loss of R waves in midprecordial leads and prominent Q waves in leads I and aVL associated with ALCAPA are not present.Download figureDownload PowerPoint Figure 2. ECG of patient on day 3 of presentation after medical management. Typical abrupt loss of R waves in midprecordial leads associated with ALCAPA is clearly seen. Typical prominent Q waves in leads I and aVL are present. Conversely, typical prominent Q waves in lead V6 (Figure 1) are not present. Note, Figure 1 is at full standard (10 mm/mV), and Figure 2 is at half standard (5 mm/mV).FootnotesCorrespondence to Curt G. DeGroff, MD, Cardiovascular Flow Dynamics Laboratory, UCHSC, The Children’s Hospital, 1056 E 19th Ave, B100, Denver, CO 80218. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hoffman J (2012) Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants, Pediatric Cardiology, 10.1007/s00246-012-0599-7, 34:3, (489-491), Online publication date: 1-Mar-2013. Ramírez S, Curi-Curi P, Calderón-Colmenero J, García J, Britton C, Erdmenger J, Buendía A and Cervantes-Salazar J (2011) Outcomes of Coronary Reimplantation for Correction of Anomalous Origin of Left Coronary Artery From Pulmonary Artery, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2011.04.014, 64:8, (681-687), Online publication date: 1-Aug-2011. Ramírez S, Curi-Curi P, Calderón-Colmenero J, García J, Britton C, Erdmenger J, Buendía A and Cervantes-Salazar J (2011) Resultados del reimplante coronario para la corrección del origen anómalo de la coronaria izquierda a partir de la arteria pulmonar, Revista Española de Cardiología, 10.1016/j.recesp.2011.04.015, 64:8, (681-687), Online publication date: 1-Aug-2011. Cohen M and Berger S (2010) The electrocardiogram as an adjunct in diagnosing congenital coronary arterial anomalies, Cardiology in the Young, 10.1017/S1047951110001101, 20:S3, (59-67), Online publication date: 1-Dec-2010. El-Feky M and Weerakkody Y (2010) Anomalous left coronary artery from the pulmonary artery Radiopaedia.org, 10.53347/rID-9750 April 24, 2001Vol 103, Issue 16 Advertisement Article InformationMetrics Copyright © 2001 by American Heart Associationhttps://doi.org/10.1161/01.CIR.103.16.e85 Originally publishedApril 24, 2001 PDF download Advertisement