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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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A Case Report of Subtle EKG Abnormalities in Acute Coronary Syndromes Indicative of Type One Myocardial Infarction

Paige Matijasich1, Patrick Bruss2, Gregory Reinhold2

  • 1University of Toledo College of Medicine and Life Sciences, College of Medicine, Toledo, OH.

Journal of Education & Teaching in Emergency Medicine
|July 19, 2023
PubMed

Insights

Subtle EKG changes in patients with cardiac risk factors can indicate significant coronary artery disease. Early intervention is crucial even without ST-elevation myocardial infarction (STEMI) criteria.

Area of Science:

  • Cardiology
  • Diagnostic Electrocardiography

Background:

  • Subtle electrocardiogram (EKG) abnormalities can be indicative of significant coronary artery disease (CAD).
  • ST-elevation criteria for ST-elevation myocardial infarction (STEMI) are not always present in acute coronary events.
  • Prompt recognition of cardiac symptoms and risk factors is crucial for diagnosis.

Purpose of the Study:

  • To report a case of significant coronary artery disease presenting with subtle EKG abnormalities.
  • To highlight the importance of clinical context in interpreting non-diagnostic EKGs.
  • To emphasize the need for emergent intervention in high-risk patients.

Main Methods:

  • Case report of a 54-year-old male with cardiac risk factors and symptoms.
  • Initial electrocardiogram (EKG) interpretation.
  • Point-of-care troponin level measurement.
  • Cardiac catheterization.

Main Results:

  • Initial EKG showed subtle abnormalities but was not diagnostic for STEMI.
  • Elevated troponin level (0.10 ng/mL) indicated myocardial injury.
  • Cardiac catheterization revealed occlusion of the right coronary artery (RCA) and left circumflex artery.
  • Successful stenting of occluded arteries was performed.

Conclusions:

  • Focal repolarization abnormalities, when combined with cardiac risk factors and symptoms, may suggest significant coronary artery disease.
  • Emergent cardiac catheterization and intervention are warranted in such cases, even without classic STEMI criteria.
  • This case underscores the diagnostic value of integrating EKG findings with clinical presentation and biomarkers.

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