A middle-aged woman with a history of hypertension presented with typical chest pain. Her BP was 160/80. Here was her presenting ECG, with chest pain:
The pain improved with Nitroglycerine. Creatinine was 4.3. She underwent another ECG at 6 hours (when she was pain free):
The troponin peaked at 16 and there was a "probable" inferior wall motion abnormality.
Because the patient had advanced renal insufficiency and because there was "no evidence for a current of injury on her presenting EKG's", a non-invasive approach was undertaken. While undergoing a stress test as a part of the non-invasive approach, she developed chest pain and hypotension and had this ECG:
Looking back, one can see ST elevation in V1-V3 on the initial ECG that is nonspecific, but, in retrospect, is probably due to RV Injury.
The pain improved with Nitroglycerine. Creatinine was 4.3. She underwent another ECG at 6 hours (when she was pain free):
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The T-waves in leads II, III, and aVF are now significantly smaller, the reciprocal ST depression is less, and the T-wave in aVL is upright. The T-wave in I has also changed. |
The troponin peaked at 16 and there was a "probable" inferior wall motion abnormality.
Because the patient had advanced renal insufficiency and because there was "no evidence for a current of injury on her presenting EKG's", a non-invasive approach was undertaken. While undergoing a stress test as a part of the non-invasive approach, she developed chest pain and hypotension and had this ECG:
Looking back, one can see ST elevation in V1-V3 on the initial ECG that is nonspecific, but, in retrospect, is probably due to RV Injury.
Dr. Smith, in the first ECG T wave can be seen high in relation to qrs greater in DIII, in addition to depression st in DI. It would have been useful to record leads V3R, V4R on the basis of st segment elevation in V1.
ReplyDeleteClinical case very instructive.
Thank you Dr. Smith
Vittorio Masciulli