Rapid Cure of Silent Ischæmia
Report:
Sinus rhythm
ST segment depression c/w ischæmia
Comment:
This one was delightfully easy to solve. The strips showing ST depression were all obtained with the patient sitting out in a chair, completely asymptomatic. I sat her up in bed to see the ST segment drop on her bedside monitor; it normalised when she lied down again85. Then I repeated the exercise, for a recording (Fig 117a).
For this reason the stress tests routinely obtain supine and upright recordings prior to actual exercise.
Silent ischæmia of course does happen, most often recorded on Holter monitors and telemetry. It is significant and easy to verify, once detected. But here are pitfalls, like the one shown.
117a.
118. Routine monitoring of a 56 year old lady with unstable angina in CCU. Unstable T waves?
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