Left Main Coronary Artery Pattern
Report:
Sinus rhythm 90/min
Probable left ventricular hypertrophy
ST/T changes c/w infarction/ischæmia
Main left coronary artery lesion pattern
Comment:
Diffuse ST segment depression â sparing, oddly enough, in this example, aVL â connotes extensive ischæmia or infarction. The modest elevation in V1 is much less than in the neighbouring aVR; this is typical of left main CA lesions causing an acute coronary syndrome (ACS)2. Serum troponin rose the next day to 29.5 µ/L, leaving one to conclude that some of the repolarisation changes were due to acute infarction, some to ischæmia and yet some, possibly, to pre-existing LVH.
The LVH voltage is seen in the frontal leads (R1 + S3 > 26 mm, RaVL > 13 mm) and in RV6 > RV5. LVH probably accounts for the (unchanging) QS complexes in V1-2.
Below is an almost identical tracing taken three hours later.
2a. The junctional SVEBâs Pâ is invisible in the V1 rhythm strip but quite obviopus in lead aVF and above. 3. 75 year old man with chest pain.
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