Indigestion? - STA HealthCare Communications

ECG clinic
“Indigestion?”
By Keith J.C. Finnie, MB, ChB; and L.J. Melendez, MD
Vignette
Question
The electrocardiogram (ECG) shown in Figure 1
was taken in a 44-year-old patient complaining
of retrosternal and epigastric discomfort (“like
indigestion”).
What is your electrocardiographic interpretation?
Figure 1
Dr. Finnie is professor of medicine, University of Western
Ontario, and site chief of cardiology, London Health Sciences
Centre, Victoria Campus, London, Ontario.
Dr. Melendez is professor of medicine, University of Western
Ontario, and cardiologist, London Health Sciences Centre,
Victoria Campus, London, Ontario.
The Canadian Journal of Diagnosis / January 2003
47
ECG Clinic
Answer
The conspicuous abnormality shown by this
ECG is the inversion of the T-wave in leads V1
through V4. It is also appreciable in leads III
and AVF. Close inspection of the ST-segment
shows elevation in leads V2 through V4. This
association of ST-segment elevation with terminal inversion of the T-wave is highly specific of
disease of the proximal left anterior descending
coronary artery and is indicative of severe
ischemia, injury or non-transmural necrosis of
the interventricular septum. Because this territory includes the inferoapical region of the left
ventricle, ischemic changes in this territory
may be reflected in some of the “inferior wall
leads,” namely II, III and AVF.
T-wave inversion not accompanied by STsegment elevation is sometimes seen in precordial leads V1 to V3 in normal individuals,
especially in black patients. It is not associated with ST-segment elevation. On the other
hand, isolated ST-segment elevation with a
configuration of a recumbent italic “S” may be
found in precordial leads V1 to V3 of normal
individuals, especially if there is increased
amplitude of the QRS complexes in the same
leads. However, it is not accompanied by terminal inversion of the T-wave. In all cases,
electrocardiographic changes should be
viewed in light of the patient’s history and
other findings. Reference to previous electrocardiograms may be helpful. Dx
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