A 51-year-old man presents to the emergency department with central chest pain and dyspnoea.
DESCRIPTION:
- Ventricular rate 116 bpm
- Sinus rhythm
- Normal PR interval 150 ms
- Left QRS axis deviation (-33°)
- Normal QRS duration 80 ms
- ST elevation in the inferior leads (II, III, aVF; III > II)
- Reciprocal ST depression in leads I and aVL
- ST elevation anterolateral precordial leads V3-6
- Poor R wave progression
- Normal QTc 417 ms
INTERPRETATION:
Inferoanterolateral ST elevation myocardial infarction:
DDx:
- Occluded dominant RCA
- Occluded wrap-around LAD
- Triple vessel disease
CASE RESOLUTION:
Percutaneous transluminal coronary angioplasty (PTCA):
- LMCA: Mild disease.
- LAD: Moderate diffuse disease, which appeared worse in mid vessel.
- LCx: Non dominant. Severe disease affecting multiple branches.
- RCA: Large. Dominant. Occluded in mid vessel.
- LVgram: Not performed. EDP 19 mmHg.
Successful PCI of occluded RCA.
