Thursday, April 23, 2009

Interesting ECG (4)

A 50 year-old man with diabetes/ hypertension/ ischemic heart disease presented with acute onset of limbs weakness, right side more severe than left (power 3/5 and 4/5 respectively). He has otherwise no complaint of dyspnea or chest pain. History revealed that he was admitted about a month ago for an ACS (acute coronary syndrome) event. His ECG was noted to as below:



Base on the clinical scenario and the ECG, what do you think is the diagnosis?

(Answer's in comment)


Also read:
Interesting ECG (1)
Interesting ECG (2)
Interesting ECG (3)

13 comments:

Huicy said...

with the ST elevation still present in the precordial leads 1 month after the ACS event, i suspect the presence of ventricular aneurysm which may cause stasis of blood flow and thus increase the risk of embolic stroke.
In this case, i would order the CT(brain) to rule out/in the embolic stroke.

Darren Lee said...

I apologize that I couldn't include the whole ECG. The ECG actually shows deep Q waves over anterior leads with ST elevations. And this man actually had multiple cerebral infarct.

In view of the presentation with the ECG findings, left ventricular aneurysm with mural thrombus secondary to previous anterior myocardial infact was suspected and it was confirmed with echocardiogram. LV aneurysm typically occurs 4-6 weeks post MI and can cause systemic embolism if patient's not anticoagulated!

Darren Lee said...

Huicy: Ha I only saw ur answer after I posted mine..ya you got it right!;)
But one another possibility is he might be having a recurrent infarct, though silent but he's diabetic, so a Troponin test is required too.

confessions of a medical student said...

i think the holidays spoilt me... all the sudden, i realised how much i missed ECGs...

Zzzyun said...

haha i could only think of recurrent infarct :P

well that shows how much i still have to learn... >.<

Huicy said...

nvm, in fact i need to thank you for sharing and give us the opportunity to improve ourselves. thanks.

Sonnet said...

I think he passed recent ACS, may be recent anterior MI. YThere is still residual ST elevation with Pathologic Q in precordial leads. He has no CP or Orthopnea on rest. So it may be dilated or aneurysmally dilated LV.
Echo will help. thanks.

Sonnet said...

I invite you and your friends to this collection of ECG:
http://tabibqulob.blogspot.com/2009/03/some-ecgs-1.html

ALL THE BEST

MP said...

could giving him Aceinhibitor and anticoagulante him would help to prevent this complications?

Nic said...

way too complicated for me

Nitrile Gloves said...

A typical electrocardiograph runs at a paper speed of 25 mm/s, although faster paper speeds are occasionally used. Each small block of EKG paper is 1 mm2. At a paper speed of 25 mm/s, one small block of ECG paper translates into 0.04 s (or 40 ms). Five small blocks make up 1 large block, which translates into 0.20 s (or 200 ms). Hence, there are 5 large blocks per second.

nitrile exam gloves

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