Coronary Artery Dissection

Report:

Fig 111:

Sinus bradycardia 40/min

Left atrial abnormality (LAA) – best seen in lead 2

Left ventricular hypertrophy voltage

Fig 111a:

Sinus bradycardia 40/min

SVEB (last beat)

Left atrial abnormality (LAA)

First degree AV block

Acute extensive anterior infarction or ischæmia

Comment:

The commonest cause of this scenario is coronary artery dissection during the procedure. The stent may have delayed its presentation somewhat. The patient was rushed to the theatres for urgent CABG to the dissected LAD artery and did well, although an anterior infarction was sutained (Figs 111b, 111c, 111d, 111e).

The subject has been reviewed recently81.

The tombstoning complexes are often saddle-shaped, like in pericarditis, but massive ST elevation precludes the latter diagnosis. The elevation in pericarditis practically never exceeds 5mm.

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