A 73-year-old man presents to the emergency department with central chest tightness radiating to the left side of his jaw.
Describe and interpret his initial 12-lead electrocardiogram:
- Ventricular rate 86 bpm
- Sinus rhythm
- Normal PR interval 174 ms
- Normal QRS axis (29°)
- Normal QRS duration 92 ms
- ½-1 mm ST elevation in the inferior leads (II, III, aVF) with associated hyperacute T waves
- Hint of downsloping (reciprocal) ST depression in aVL)
- Downsloping ST depression in anterior precordial leads V1-3 with associated down-up biphasic T waves
- ½ mm ST depression in V4
- Hyperacute T waves also present in leads I, aVR, V5+6
- Normal QTc 423 ms
Highly suspicious for an occluded left circumflex coronary artery.
Patient underwent emergency coronary angiography and and received a drug eluting stent to a critical mid-left circumflex lesion.