- How would you interpret this ECG?
- What is the likely “culprit” artery?
|Figure-1: 12-lead ECG obtained from a 51-year old man with new-onset chest pain. What is the likely “culprit” artery? NOTE — Enlarge by clicking on the Figure.|
- The rhythm is sinus tachycardia at a rate just over 100/minute. The PR and QRS intervals are normal — but the QT appears to be prolonged. The axis is normal. There is no chamber enlargement.
- Q-R-S-T Changes: There are small and narrow q waves in most infero-lateral leads. R wave progression is normal, with transition occurring between leads V2-to-V3. There are dramatic ST-T wave changes. There is over 10mm of J-point ST segment depression in several anterior leads. All lateral leads show marked ST segment elevation, which nearly attains 10mm in lead V6!
|Figure-2: Follow-up ECG obtained after reperfusion of the acutely occluded LCx artery. Virtually all ST-T wave abnormalities that were seen in Figure-1 have resolved!|
- The dramatic and extensive amount of the ST-T wave changes seen in Figure-1 is most probably attributable to the acute insult of LCx occlusion on top of severe underlying multi-vessel disease.