Electrocardiographic clue for a mid-LAD lesion
Rohat Ak1, Fatih Doganay1, Ozge Ozberk Onur2
1Department of Emergency Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
BMJ Case Reports
|March 19, 2016
Summary
Serial electrocardiograms (ECGs) are crucial for diagnosing coronary artery disease. Isolated T-wave inversion in lead aVL can indicate left anterior descending artery occlusion, prompting urgent intervention.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Electrocardiography (ECG) is a primary diagnostic tool for coronary artery disease (CAD).
- ST and T wave changes on ECG can help predict the location of occluded coronary arteries.
- Reciprocal ECG changes can be the sole indicator of acute myocardial ischemia.
Observation:
- A 49-year-old woman presented with chest pain and initially normal ECG findings.
- Serial ECG monitoring revealed new T-wave inversions in leads aVL and V2.
- Troponin levels became positive, correlating with ECG changes.
Findings:
- Coronary angiography confirmed a 90% occlusion in the mid-left anterior descending (LAD) artery.
- The isolated T-wave inversion in lead aVL was the key indicator of significant LAD stenosis.
- Serial ECGs are vital for detecting evolving ischemic events.
Implications:
- Emergency physicians must remain vigilant for subtle ECG changes, such as isolated T-wave inversion in aVL.
- Prompt recognition of these changes can lead to timely cardiac catheterization and intervention.
- This case highlights the importance of continuous ECG monitoring in patients with suspected myocardial ischemia.
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