Answer - Rhythm Puzzle may 2005: Difference between revisions

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m (New page: 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 tra...)
 
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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

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