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Puzzle 2008 04 014 Answer: Difference between revisions
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[[Image:Puzzle_2008_04_014_fig1a.png|Figure 1A|thumb]] | [[Image:Puzzle_2008_04_014_fig1a.png|Figure 1A|thumb]] | ||
[[Image:Puzzle_2008_04_014_fig1b.png|Figure 1B|thumb]] | [[Image:Puzzle_2008_04_014_fig1b.png|Figure 1B|thumb]] | ||
[[Image:Puzzle_2008_04_014_fig2.png|Figure 2|thumb]] | |||
A 57-year-old man collapsed after one hour of | A 57-year-old man collapsed after one hour of | ||
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==Answer== | ==Answer== | ||
The ECG in figure 1A shows sinus rhythm, an intermediate electrical axis, and a normal PQ interval and QRS duration. Furthermore, obvious ST-segment elevation (STE) preceded by pathological Q waves inthe right precordial leads, STE in leads I and aVL, and reciprocal ST-segment depression in the inferior leads all imply an acute occlusion of the left anterior descending (LAD) artery, located proximal to the firstseptal and first diagonal branch.<cite>Engelen</cite><cite>Tamura</cite> The recording in figure 1B reveals a regular rhythm with broadened QRS complexes, likely a ventricular rhythm, of approximately 100 beats/min without visible atrial activation. The broadened QRS complexes(± 0.12 s) show a right bundle branch block (RBBB) configuration and a left anterior fascicular block, which causes the electrical axis to shift leftwards. Corrected QT intervals are normal. ST-segment shifts are com-parable to those in figure 1A. Both the left anterior fascicle and the right bundlebranch are supplied by septal branches of the proximal LAD artery. | The ECG in figure 1A shows sinus rhythm, an intermediate electrical axis, and a normal PQ interval and QRS duration. Furthermore, obvious ST-segment elevation (STE) preceded by pathological Q waves inthe right precordial leads, STE in leads I and aVL, and reciprocal ST-segment depression in the inferior leads all imply an acute occlusion of the left anterior descending (LAD) artery, located proximal to the firstseptal and first diagonal branch.<cite>Engelen</cite><cite>Tamura</cite> The recording in figure 1B reveals a regular rhythm with broadened QRS complexes, likely a ventricular rhythm, of approximately 100 beats/min without visible atrial activation. The broadened QRS complexes(± 0.12 s) show a right bundle branch block (RBBB) configuration and a left anterior fascicular block, which causes the electrical axis to shift leftwards. Corrected QT intervals are normal. ST-segment shifts are com-parable to those in figure 1A. Both the left anterior fascicle and the right bundlebranch are supplied by septal branches of the proximal LAD artery. | ||