Conclusion to Snapshot Case: 85yo M – Chest Pain

This is the conclusion to the Snapshot Case from a couple of days ago. If you haven’t already done so, I suggest reviewing the very brief initial case description. Here again is the EKG from Tuesday’s case. This tracing is nearly pathognomonic for true occlusion of the left main coronary artery (LMCA), resulting in a “left main STEMI.” Since this a Snapshot case with no follow-up this diagnosis cannot be confirmed, but it is a rather unique pattern I have yet to see mimicked by any other form of ACS. I’m not surprised that few, if any, readers were familiar with this presentation. It is not commonly taught, and in fact I only came across it from seeing a few cases and reading case reports. Let’s review the pattern of ST-deviation that we are seeing… First, consider the limb leads. There is massive ST-elevation in leads I and aVL with massive reciprocal ST-depression in leads II, III, and aVF. This pattern is consistent with STEMI of either the left main (LMCA), left anterior descending (LAD), or circumflex (LCx) coronary artery. Though there is really no way to differentiate them using the limb leads alone, the magnitude of the ST-elevation—enough to produce a true “tombstone” pattern in I and aVL—certainly suggests a large area of ischemic myocardium consistent with the LAD or LMCA. For those following my 360 Degree Heart series, here’s what the leads look like displayed in that fashion (though it adds nothing ...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 360 Degree Heart Cases Snapshot Tom Bouthillet Vince DiGiulio Source Type: research