PMID: 28529306May 23, 2017Paper

Normalization of Diffuse ST-Depression with aVR Elevation After Rehydration in a Patient with Severe Aortic Stenosis

The American Journal of Case Reports
Sachin R PatelGeorge Rust

Abstract

BACKGROUND Isolated ST elevation in lead aVR in combination with global ST depression with normalization after rehydration is a unique electrocardiographic pattern that is associated with a broad range of diagnoses. Its association with left main coronary artery disease and other acute coronary syndromes suggest the need for early and aggressive cardiac evaluation. CASE REPORT A 53-year-old man presented with altered mental status and loss of consciousness. He was unresponsive, hypotensive, tachycardiac, and diaphoretic. An initial ECG showed diffuse ST depression with isolated ST elevation in lead aVR, and initial troponin levels were negative. After rehydration, a repeat ECG showed sinus rhythm without ischemic changes. An emergent echocardiogram showed severe aortic stenosis and global hypokinesis. Repeat troponin results were elevated. The patient had 2 subsequent cardiac arrests. Emergent cardiac catheterization showed an occluded right coronary artery with collaterals and complete occlusion of the LAD. Urgent intra-aortic balloon pump was placed, followed by coronary artery bypass graft, aortic valve replacement, and a placement of a left ventricular assist device. Despite maximal hemodynamic support, the patient died aft...Continue Reading

References

Jan 1, 1996·Journal of Electrocardiology·U S PahlmG S Wagner
Apr 16, 2008·The American Journal of Emergency Medicine·Filip M SzymańskiGrzegorz Opolski
Nov 7, 2008·The New England Journal of Medicine·Robbert J de WinterUNKNOWN Interventional Cardiology Group of the Academic Medical Center
Mar 28, 2013·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Edward Kim, Yochai Birnbaum

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