Acute Coronary Syndrome with ST Segment Elevation: New Electrocardiographic Pattern


A 58-year-old man with a history of hypertension and diabetes, presented to the emergency department (ED) after 2 hours of oppressive, severe chest pain radiating to the left arm and associated with dyspnea. Upon arrival he was stable, an ECG was performed that demonstrated an isolated elevation of the J point in DIII, with depression of the J point in DI, DII, AVL, V4 to V6, with isoelectric ST segment in AVF. Troponine was not expected because an ST equivalent pattern was suspected. Should the patient be treated for an acute coronary syndrome with elevation of the ST or non-ST elevation based on the ECG findings?

Acute Coronary Syndrome with elevation of the inferior ST segment. The ECG in Figure 1 shows an isolated elevation of the J point in DIII without concomitant elevation of the contiguous derivatives in the inferior face (subtle under-elevation of the J point in DII and isoelectric ST segment in AVF) and ST-segment depression in DI, AVL, V4 to V6 as reciprocal changes on the lateral side in the setting of an inferior ST myocardial infarction.The patient received aspirin, clopidogrel and IV nitroglycerin, he was then transferred for urgent cardiac catheterization that showed an anterior descending coronary artery with 99% occlusion in its proximal and middle portion, the right coronary artery was codominant with 100% occlusion in the proximal third, the circumflex artery with multiple tandem lesions and 99% occlusion of chronic appearance.

The patient was transferred to the intermediate care unit and received treatment with IV Tirofiban. The echocardiogram revealed a preserved ventricular function with 45% ejection fraction and akinesia of the inferobasal segment. He was referred for surgical revascularization due to multivessel disease and impossibility of percutaneous intervention.

https://www.stephypublishers.com/sojccts/pdf/SOJCCTS.MS.ID.000508.pdf




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