An 82-year-old man presents to the Emergency Room because of chest discomfort. He had remote coronary artery bypass grafting (CABG) and was found to have non-sustained ventricular tachycardia on a Holter monitor a few months ago. He has a history of hyperlipidemia, and his serum troponin level is normal. An electrocardiogram (ECG) is performed (Figure 1).
Figure 1
The ECG shows which of the following?
Show Answer
The correct answer is: E. B and D.
The ECG shows sinus rhythm with prolonged PR interval. The QRS axis is normal (42 degree), and the two PVCs are present. The R wave is greater than the S wave in lead V2. The initial R wave in V1 is fragmented. This, along with the ST depression and upright T wave, indicates age undetermined posterior (lateral) infarct. Coronary angiography revealed that the native left circumflex coronary artery had high grade obstruction, and the saphenous vein graft (SVG) to the circumflex was 90% stenosis at the anastomosis. The echocardiogram showed akinesis of the posterior-lateral wall.
References
Levis JT. ECG Diagnosis: Isolated Posterior Wall Myocardial Infarction. Perm J 2015 Fall;19(4):e143-4.
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