Sudden Death Syndrome: Main Left Pattern

Report:

Atrial fibrillation with mean response 85/min

Indeterminate axis

Diffuse ST/T changes c/w MI/ischæmia

Comment:

The patient had recurrent VF and fatal cardiogenic shock in Casualty.

The pattern of marked ST segment depression with elevation in aVR and V1, the former exceeding the latter, is characteristic of left main coronary artery lesions in acute coronary syndromes.

The axis is called indeterminate (it never actually is) when the 6 frontal leads are more or less equiphasic. It provides more satisfaction to the writer than to the viewer of the report.

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