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==
[[Image:Puzzle_2008_04_014_fig1b.png|Figure 2|thumb]]
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.


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