42 years old lady with known case
of skin vitiligo, stroke with right hemiplegic unsure of type and hypertension
was referred for right elbow abscess. She otherwise denied typical chest pain,
no nausea and vomiting, diaphoresis or syncopal attack
On examination, vital signs are
normal. heart S1S2 with PSM at mitral region grade 4, no basal crepitation, no
raised JVP or ankle edema.
ECG taken shows generalized down
sloping ST depression with ST Elevation >1 mm at lead aVR
CXR shows minimal cardiomegally with
no APO changes.
Patient remain asymptomatic and
repeated ECG no dynamic changes.
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Impression
Generalized ST depression with ST
elevation at the lead AVR is indicative of left main coronary artery disease
and not necessarily means ischemia as patient do not have typical chest pain.
Other differential such as systemic
illness like anemia or electrolyte imbalance should be seek. Serial cardiac
enzyme would be very useful to exclude myocardial ischemia.
LV strain pattern possible x dr?
ReplyDeleteI have consulted two emergency physician with one of them is sub in cardio.. this is their response..name is not revealed because this consultation is made just for learning purpose and not for patient management as this is retrospective consultation
ReplyDelete1) Dr A
Left coronary disease. or systemic illness (hyo K / anemia)
2) Prof R
Asymptomatic, hypertensive, cardiomegaly, ECG- SR, LVH, ST depression at >8 leads, ST up at aVR. My impression is asymptomatic triple vessels disease. If patient presents with chest pain then i consider LMS occlusion @ostial LAD occlusion and? ? Acute PE. Silent MI occurs in 20% of population. If silent MI is strongly considered, MONICA criteria needs to be fullfilled.
jacknaim