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