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Answer - Rhythm Puzzle may 2005: Difference between revisions
Answer - Rhythm Puzzle may 2005 (view source)
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{{NHJ| | |||
|mainauthor= '''T.A. Simmers, A.A.M. Wilde''' | |||
|edition= 2005:5,195 | |||
}} | |||
[[Image:Puzzle_2005_5_195_fig1.jpg|Figure 1|thumb]] | |||
An otherwise healthy 66-year-old male was referred | |||
with complaints of central chest pain. He was not | |||
on any medication, and there were no risk factors for | |||
coronary artery disease. Pain invariably occurred at rest | |||
and subsided spontaneously within approximately 15 | |||
minutes. Physical examination, laboratory testing, | |||
resting ECG and stress test were all within normal limits; | |||
myocardial perfusion scintigraphy revealed no ischaemia. | |||
During hospitalisation the patient experienced a | |||
recurrence, at which time an ECG (figure 1) was taken. | |||
En route to emergency coronary angiography the ECG | |||
normalised and the symptoms resolved. Angiography | |||
showed no significant coronary stenosis. | |||
* '''What is the most likely diagnosis?''' | |||
* '''What diagnostic and/or therapeutic measures should be taken?''' | |||
==Answer== | |||
The most striking feature of this ECG is the ST segment elevation and T-wave inversion in leads V1 to | The most striking feature of this ECG is the ST segment elevation and T-wave inversion in leads V1 to | ||
V5, aVL and aVR with reciprocal depression in the inferior leads. Findings suggest transmural ischaemia caused by a proximal left anterior descending artery (LAD) lesion. The patient’s history of pain at rest, the ECG during pain and (lack of) findings at coronary angiography together lead to a diagnosis of variant or Prinzmetal angina, in this case electrocardiographically due to proximal LAD spasm. The mainstay of therapy is vasodilative medication (i.e. nitrates and calcium channel blockers) and statins and ACE inhibitors for their effects on the endothelium. Second-line therapy | V5, aVL and aVR with reciprocal depression in the inferior leads. Findings suggest transmural ischaemia caused by a proximal left anterior descending artery (LAD) lesion. The patient’s history of pain at rest, the ECG during pain and (lack of) findings at coronary angiography together lead to a diagnosis of variant or Prinzmetal angina, in this case electrocardiographically due to proximal LAD spasm. The mainstay of therapy is vasodilative medication (i.e. nitrates and calcium channel blockers) and statins and ACE inhibitors for their effects on the endothelium. Second-line therapy | ||