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Subtle signs of myocardial ischaemia on ecg
 

Subtle signs of myocardial ischaemia on ecg

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Subtle signs of myocardial ischaemia on ecg

Subtle signs of myocardial ischaemia on ecg

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    Subtle signs of myocardial ischaemia on ecg Subtle signs of myocardial ischaemia on ecg Presentation Transcript

    • SUBTLE SIGNS OF MYOCARDIAL ISCHAEMIA ON ECG Dr Ingole, MD Internal Medicine Pune
    • • 55 yr old Female Patient admitted with breathlessness on exertion • Past History : Operated for Pituitary tumor 2 yrs ago • Personal History : Unmarried, Menopausal
    • 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
    • Systemic Examination • RS : NAD • CVS : NAD
    • Clinical Impression • Acromegaly with Operated Pituitary adenoma to r/o underlying cardiac disease- CAD vs cardiomyopathy secondary to acromegaly
    • Investigations • All routine Investigations Normal • ECG : NSR, LVH
    • 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.
    • ECG was done …
    • 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
    • Himalayan T Wave
    • Hyperkalemia
    • Wellen’s T wave
    • De Winter’s T Wave
    • Inverted Fish Hook sign
    • Isolated aVL T inversion
    • LMCA
    • Thanks