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March EKG Answers

March 2005 EKG Case:

 A 28 year old NASCAR race driver has intermittent dull central chest pain for the last two days associated with nausea, diaphoresis and radiation of pain to the left upper extremity. He has no past medical history.

What does the EKG show and what is the diagnosis?

Rate:  55
Rhythm:  Sinus rhythm
Axis:  Normal
PR:  Normal
QRS:   Normal
T:   Biphasic T waves V1-V3, II, III, AVR, AVF, AVL, and V6
     Deep symmetrical T wave inversion V4, V5

EKG Diagnosis: Anterior subendocardial (non Q-wave) myocardial infarction or ischemia
 

Clinical diagnosis: Unstable angina
 

Practice Points: -This EKG shows T wave inversion in V2-V6.  This is compatible with ischemia, or subendocardial infarction if associated with an enzyme rise

    • -Q waves do not occur in the absence of transmural infarction
      • -The diagnosis of subendocardial infarction is based on a typical history of chest pain, EKG changes (ST segment depression, ST segment elevation and T wave inversion) and cardiac enzyme elevation (less marked than in transmural infarction)
      • -Subendocardial infarcts have lower in-hospital mortality but higher re-infarction rates
      • -Subendocardial infarcts account for approximately 20% of all infarcts and will often progress to a Q wave infarct within a year.
      • -Patients with subarachnoid hemorrhage may have very similar EKG changes, due to release of noradrenaline.

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