Non-Coronary Ischæmia

Report:

Sinus rhythm 80/min

Borderline first degree AV block

ST/T changes suggestive of ischæmia

Comment:

This is a good example of horizontal (“plane”) ST segment depression highly suggestive – almost diagnostic – of ischæmia. The associated T wave changes are more modest, but they, too, suggest ischæmia: TV1 > TV6 and T3 > T1. In this case, however, both are due to LVH engendered by severe aortic stenosis. The coronary arteries were normal and the LV function was impaired.

The LVH itself is not electrocardiographically visible: the repolarisation changes are atypical, while the voltages and the LAA are not there. Presumably the progressive LV dysfunction and myocardial damage are responsible, through a variety of mechanisms. Typical LVH with ST/T changes (and associated LAA) were present in earlier traces (Fig 15a).

The lesson is that one should try not to read too much into an ECG.

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