Acute Coronary Syndrome

Report:

Sinus rhythm 97/min

ST segment depression c/w infarction/ischaemia

Comment:

The distribution of ST segment shifts is similar, but less pronounced, than in Case 2: diffuse ST depression with elevation confined to aVR and V1, greater in aVR. This may well be another example of main left coronary artery stenosis.

The trace normalised in an hour (Fig 56a), with minor residual ST elevation in V1. The troponin rose to 14 mcg/L over the next 36 hours: this episode was an infarct.

In both tracings the presence of an established posterior infarction cannot be discounted: 0.04” primary R wave in V1 and early transition favour it. It matters little in this setting; the patient needs urgent angiography anyway.

56a.

57. 47 year old man with history of remote myocardial infarction, transferred from a country hospital after failed thrombolysis.

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