Coronary Artery Dissection

Report:

Fig 111:

Sinus bradycardia 40/min

Left atrial abnormality (LAA) – best seen in lead 2

Left ventricular hypertrophy voltage

Fig 111a:

Sinus bradycardia 40/min

SVEB (last beat)

Left atrial abnormality (LAA)

First degree AV block

Acute extensive anterior infarction or ischæmia

Comment:

The commonest cause of this scenario is coronary artery dissection during the procedure. The stent may have delayed its presentation somewhat. The patient was rushed to the theatres for urgent CABG to the dissected LAD artery and did well, although an anterior infarction was sutained (Figs 111b, 111c, 111d, 111e).

The subject has been reviewed recently81.

The tombstoning complexes are often saddle-shaped, like in pericarditis, but massive ST elevation precludes the latter diagnosis. The elevation in pericarditis practically never exceeds 5mm. 111b. Half an hour later, ST segments are subsiding but new anteroseptal Q waves have appeared. The patient was taken to the OR.

111c. On return from the OR, the large Q waves are established and the ST segments are almost isoelectric. The T waves are still upright and prominent, but no more so than before it all started, in Fig 111. A forme fruste of the stage of illusion in evolving infarction.

111d. Final ECG in this series, one day later. The T waves are on their way down.

112. 42 year old man in shock in Casualty.

112a. Same man 30 minutes later, about to be transferred to Catheter Lab. What are the likely findings?