Subtle signs of myocardial ischaemia on ecg
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22-Oct-2014 -
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Transcript of Subtle signs of myocardial ischaemia on ecg
SUBTLE SIGNS OF MYOCARDIAL ISCHAEMIA ON ECG
Dr Ingole, MD Internal Medicine
Pune
• 55 yr old Female Patient admitted with breathlessness on exertion
• Past History : Operated for Pituitary tumor 2 yrs ago
• Personal History : Unmarried, Menopausal
On Examination
• Afebrile• Pulse 84/min, Regular • BP 140/90 mmHg • Built Stout • Broad Big Supra Orbital Ridges • Big Nose • Macroglossia • Big Spade like Hands, Wide and Big feet
Systemic Examination
• RS : NAD• CVS : NAD
Clinical Impression
• Acromegaly with Operated Pituitary adenoma to r/o underlying cardiac disease- CAD vs cardiomyopathy secondary to acromegaly
Investigations
• All routine Investigations Normal • ECG : NSR, LVH
Next day …
• Patient had sudden onset, typical chest pain with hypotension in the morning.
• Impression : Acute Coronary Event with Cardiogenic Shock
• Resuscitation was initiated in the ward
• Patient had cardiac arrest and unfortunately could not be revived.
ECG was done …
ECG s/o ACS most probably LAD disease
SUBTLE SIGNS OF MYOCARDIAL ISCHAEMIA ON ECG
• Tall, broad T waves• NTT wave in V1• Wellen’s T waves• De Winter’s ST-T abnormality• Isolated ST depression in aVL• Inverted fish hook sign• aVR and V1…..discussed previously by Dr Karekar
Himalayan T Wave
Hyperkalemia
Wellen’s T wave
De Winter’s T Wave
Inverted Fish Hook sign
Isolated aVL T inversion
LMCA
Thanks