Case 1: An 82-Year-Old-Woman with Crescendo Angina
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
History
An 82-year-old woman presents to the ED with crescendo angina. This ECG is acquired in the emergency room at a time when the patient is pain-free:
Diagnosis
- Sinus rhythm
- Cannot rule out anterior infarction (poor R-wave progression)
- ST elevation noted in lead V3
- Non-specific ST changes
ECG 2
Her chest pain returns, and a second ECG is obtained:
ECG 2 Diagnosis
- Sinus rhythm
- Cannot rule out anterior infarction (Poor R-wave progression)
- Borderline ST elevation with deep T-wave inversions across anteroseptal leads indicative of anterior wall ischemia
ECG 3
The patient is taken to the cardiac catheterization laboratory urgently. She is found to have stenosis of the proximal-mid left anterior descending artery, and she undergoes a percutaneous intervention. This ECG is taken after the patient returns to the ward post-PCI:
ECG 3 Diagnosis
- Sinus rhythm
- Septal infarction (Q-waves in lead V1 and V2)
- Non-specific T-wave changes in lateral leads (changes of ischemia have resolved)
ECG ID: E794