Unstable Angina

Report:

Sinus rhythm 84/min

Early transition

ST segment depression suggestive of ischæmia

Comment:

There is enough horizontal (“plane”) or slowly rising (e.g., lead 2, V4) ST depression to define a positive exercise test, especially when followed by total resolution when the patient was asymptomatic (Fig 5a). The pattern is almost like the one seen in LMCA disease, except that V1 here shows no ST elevation (aVR does) and the depression is less marked. There is no substitute for angiography, however, especially in women. Anatomy is destiny.

The cardiac enzymes remained normal and she was discharged home on a ß-blocker and aspirin with view to angiography in a week’s time.

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