Subtle signs of myocardial ischaemia on ecg

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Subtle signs of myocardial ischaemia on ecg

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Subtle signs of myocardial ischaemia on ecg

  1. 1. SUBTLE SIGNS OF MYOCARDIAL ISCHAEMIA ON ECG Dr Ingole, MD Internal Medicine Pune
  2. 2. • 55 yr old Female Patient admitted with breathlessness on exertion • Past History : Operated for Pituitary tumor 2 yrs ago • Personal History : Unmarried, Menopausal
  3. 3. On Examination • Afebrile • Pulse 84/min, Regular • BP 140/90 mmHg • Built Stout • Broad Big Supra Orbital Ridges • Big Nose • Macroglossia • Big Spade like Hands, Wide and Big feet
  4. 4. Systemic Examination • RS : NAD • CVS : NAD
  5. 5. Clinical Impression • Acromegaly with Operated Pituitary adenoma to r/o underlying cardiac disease- CAD vs cardiomyopathy secondary to acromegaly
  6. 6. Investigations • All routine Investigations Normal • ECG : NSR, LVH
  7. 7. Next day … • Patient had sudden onset, typical chest pain with hypotension in the morning. • Impression : Acute Coronary Event with Cardiogenic Shock • Resuscitation was initiated in the ward • Patient had cardiac arrest and unfortunately could not be revived.
  8. 8. ECG was done …
  9. 9. SUBTLE SIGNS OF MYOCARDIAL ISCHAEMIA ON ECG • Tall, broad T waves • NTT wave in V1 • Wellen’s T waves • De Winter’s ST-T abnormality • Isolated ST depression in aVL • Inverted fish hook sign • aVR and V1…..discussed previously by Dr Karekar
  10. 10. Himalayan T Wave
  11. 11. Hyperkalemia
  12. 12. Wellen’s T wave
  13. 13. De Winter’s T Wave
  14. 14. Inverted Fish Hook sign
  15. 15. Isolated aVL T inversion
  16. 16. LMCA
  17. 17. Thanks

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