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Monday, 19 November 2012

#ECGclass - Case 16

#ECGclass Case 16 

This 64yr old man presents to his GP, with chest pain.

His pains are sharp, transient, and very localised to a finger point area in the left chest.
The pains have been present for 2-3 months and are positional in nature. (Better when he lies on either side, or sits upright. Worse on lying down on his back).
They are not aggravated by exercise, breathing or coughing.

The pains are never exertional in nature, despite him maintaining a fairly active lifestyle.

Cardiovascular and respiratory examination are normal. He seems well.

You obtain the following ECG:
(Apologies for the poor quality - this is a really old trace - but don't worry, we're looking for 'patterns' here, not detailed measurements)

Clinically he seems well, and has no pain, at the time of examination. 

What do you do next?
Anything you want to know?

Please Tweet #ECGclass any thoughts you have, or further questions, you may want to know.
Do you want any further information or tests? 

Update 1

When he comes back to your room, having had his ECG with the nurse, he asks you if it looks OK?
He then discloses that although he had't been worried about his chest pain, (he thinks it is 'muscular'), he decided that he ought to get checked, as he had a coronary stent inserted several years ago, for single vessel IHD disease. He has been symptom free since then.

Does this change your interpretation of the ECG?
Anything you want to ask?

You note a suggestive ST elevation Pattern in the Inferior leads and in the V2-V6 lateral leads.

What are your thoughts on this?
(Remember to simply describe what you see).

Update 2
Firstly, let's study the inferior leads:   II, III and aVF 
How would you describe the ST elevation in these leads?

(You may find it useful to refer back to The July 16th blog entitled "Different patterns of ST elevation").

Update 3
Now let's study chest Leads : V2-V6 
How would you describe the ST elevation in these leads?
Does it look the same as the Inferior leads?

When you've had a go,  you'll find the full discussion on the next blog!

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