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Challenges in Clinical Electrocardiography
April 11, 2011

The Serial Electrocardiogram—Discussion

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Intern Med. 2011;171(7):616-618. doi:10.1001/archinternmed.2011.100

After the initial ECG was obtained, the patient remained chest pain free. A computed tomographic angiogram was obtained expeditiously and showed no evidence of aortic dissection. The on-call cardiologist was contacted to review the ECG and discuss management strategies. The consultant suggested repeating the ECG, given the concerning initial tracing and the typical chest pain presentation. Forty-five minutes after arrival in the emergency department, while the patient was resting comfortably, a second ECG was obtained, which demonstrated marked ST-segment elevation from V2through V5(Figure 2). The cardiac catheterization team was activated for ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed a completely occluded proximal left anterior descending artery (LAD), which was opened using aspiration thrombectomy and a drug-eluting stent. After an extended hospital stay, which included severe heart failure (necessitating the use of an intraaortic balloon pump) and postreperfusion electrical instability, the patient was discharged home with cardiac rehabilitation.

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