4 hours later …
DESCRIPTION:
- Ventricular rate 50 bpm
- Sinus bradycardia
- 1st degree AV block (PR interval 260 ms)
- Normal QRS axis (4°)
- QRS duration 96 ms
- Normal R wave progression
- Slight remaining downsloping ST segment depression in the lateral leads (I + aVL, V5-6)
- Faintest hint of ST elevation in the inferior leads III + aVF with normalisation of the hyperacute T waves
- Normalisation of T wave morphology throughout
- QTc 412 ms
INTERPRETATION:
Progressive electrocardiographic normalisation following spontaneous resolution of a recent RCA occlusion.
CASE PROGRESSION:
The patient was admitted to the Coronary Care Unit, shortly after which he suffered an inferior ST elevation myocardial infarction. Emergency coronary angiography revealed a totally occlusive thrombus in the RCA which was stented.