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.
Insights
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.
Abstract:
ECG is still the first diagnostic tool for coronary artery disease. It is possible to predict the localisation of affected vessel(s) through ST and T changes on ECG. Sometimes, reciprocal changes may be the only marker of acute myocardial ischaemia, as single T-wave inversion in lead aVL may represent a coronary artery lesion in the left anterior descending (LAD). A 49-year-old woman presented to the emergency department, with left-sided chest pain. Her initial ECG showed no ischaemic changes. On the third hour ECG there was T-wave inversion in leads aVL and V2, and troponin turned positive. Coronary angiography showed 90% mid-LAD occlusion. The importance of this case is that patients with ischaemic chest pain should be followed with serial ECG. Also, emergency physicians should be alert to identify new changes on ECG, as isolated T-wave inversion in lead aVL can be the only finding to take the patient into the catheterisation laboratory.
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