Left Main Coronary Artery Lesion
Report:
Sinus rhythm
First degree AV block
PR 0.22"
ST/T changes consistent with acute coronary insufficiency
Comment:
The ECG gradually normalised over the next five hours (Fig 100a); the CPK levels remained normal. Cardiac catheter demonstrated 95% main left coronary artery stenosis and the patient was referred for urgent surgery.
It is the marked ST segment depression, rather than T wave inversion or flattening, that makes this ECG so unpleasant. It implies extensive, circumferential ischæmia. There is, however, ST segment elevation in two leads: aVR an V1. This, in the setting of marked ST depression elsewhere, makes the tracing highly suggestive of left main CA disease75, especially when the elevation in aVR exceeds that of V1. In this case, they are about equal.
In Fig 100b is a very similar ECG, from a 75 year old lady who also had 95% “main left” obstruction.
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