ECG response: May 20, 2014.

Abstract

HomeCirculationVol. 129, No. 20ECG Response: May 20, 2014 Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBECG Response: May 20, 2014 Originally published20 May 2014https://doi.org/10.1161/CIRCULATIONAHA.114.010615Circulation. 2014;129:2078–2079IntroductionECG Challenge: A 66-year-old man with a history of hypertension and hyperlipidemia presents with substernal chest burning that he felt was gastrointestinal related because it occurred shortly after lunch. However, antacids were without benefit. After 4 to 5 hours, he decided to go to an emergency room. On the basis of ECG abnormalities and elevated serum troponin and creatine kinase-MB, he was brought to the cardiac catheterization laboratory. One-vessel disease (right coronary artery) was noted, and a percutaneous coronary intervention was performed.Download figureDownload PowerPointThere is a regular rhythm at a rate of 50 bpm. There is a P wave before each QRS complex (+) with a stable but short PR interval (0.12 second). The P waves are abnormal in that they are negative in leads II, aVF, and V3 through V6. Hence, the rhythm is not a sinus but an atrial rhythm. There is ST-segment elevation in leads II, III, and aVF (▼). In addition, there are T-wave inversions in these leads (▲). The ECG shows an acute inferior wall ST-segment–elevation myocardial infarction. Along with this, there are ST-segment depressions in leads I and aVL (^), which are reciprocal changes seen with an acute ST-segment elevation inferior wall myocardial infarction. Also noted is ST-segment elevation in leads V1 and V2 (↓). When associated with an acute inferior wall myocardial infarction, these ST-segment elevations are consistent with infarction of the right ventricle, which is the chamber that lies below leads V1 and V2. Obtaining right-sided leads would be further confirmation of involvement of the right ventricle. The presence of ST-segment elevation in right-sided V3 and V4 is seen when there is infarction of the right ventricular free wall. Although the ST segment elevation in leads V1-V2 is suggestive an an acute anteroseptal infarction, the localization of ST segment changes in only V1-V2 and not other precordial leads is unusual. In addition the reciprocal changes in leads I and aVL are consistent with an inferior wall infarction as the primary area of involvement. Having both an acute inferior and anteroseptal myocardial infarction would be rare. The QT/QTc intervals are normal (400/365 milliseconds).Please go to the journal’s Facebook page for more ECG Challenges: http://goo.gl/cm4K7. Challenges are posted on Tuesdays and Responses on Wednesdays.FootnotesCorrespondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Pkwy, West Roxbury, MA 02132. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Podrid P (2014) Response to Letter Regarding Article, “ECG Response: May 20, 2014”, Circulation, 10.1161/CIRCULATIONAHA.114.012965, 130:14, Online publication date: 30-Sep-2014. Kordalis A, Lazaros G and Stefanadis C (2014) Letter by Kordalis et al Regarding Article, “ECG Response: May 20, 2014”, Circulation, 10.1161/CIRCULATIONAHA.114.011532, 130:14, Online publication date: 30-Sep-2014. May 20, 2014Vol 129, Issue 20 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.010615PMID: 24842935 Originally publishedMay 20, 2014 PDF download Advertisement SubjectsElectrocardiology (ECG)