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Challenges in Clinical Electrocardiography
July 11, 2011

An Unusual Pattern of ST-Segment Elevation—Discussion

Arch Intern Med. 2011;171(13):1147-1148. doi:10.1001/archinternmed.2011.60.1

After the initial ECG (Figure 1) was obtained, the cardiac catheterization team was activated out of concern for ST elevation myocardial infarction (MI). Given the finding of complete heart block, transcutaneous pacing electrodes were placed. Because of profound hypotension, a central venous catheter was placed to allow for vasopressor infusion and intravenous fluid resuscitation. Subsequently, the patient's chest pain began to resolve, and the second ECG (Figure 2) was obtained. Emergent coronary angiography showed an ulcerated plaque in the proximal right coronary artery with an associated 90% stenosis and an 80% stenosis in the mid portion of the left anterior descending artery. All coronary arteries had normal antegrade flow. A bare metal stent was successfully deployed to the proximal right coronary artery. No intervention was performed on the left anterior descending artery. Serum troponin-I peaked at 8.1 ng/mL. The patient had no recurrences of chest pain and was discharged a few days later.

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