This 71-year-old farmer presented with chest pain and was feeling faint. He experienced some minor chest tightness the day before while herding sheep on his quad bike. He thought he had pulled a muscle and the symptoms resolved after a short time. The next morning, while in the shower, he had a recurrence of chest tightness, which he rated at a severity of 5/10. He felt very light-headed and had to sit down so as not to pass out. The chest tightness was across the front and there was no radiation or other associated symptoms.
His only past medical history was a 5-year history of intermittent supraventricular tachycardia (SVT) which is well controlled on bisoprolol.
His vital signs were as follows:
- Blood pressure 169/89 mmHg
- Pulse rate: 62 beats per minute
- Respiratory rate: 16 breaths per minute
- Sp02: 97% on air
- Temperature: 37.2°C.
The 12-lead electrocardiogram (ECG) in Figure 1 was recorded.
What does the ECG show?
The heart rate is approximately 60 beats per minute and in sinus rhythm. The cardiac axis is normal. There is minimal ST segment elevation in the inferior and lateral ECG leads. There is also a suggestion of ST segment elevation across the chest leads.
He was triaged to the cardiac catheterisation laboratory for coronary angiography. His mid left anterior descending (LAD) coronary artery had a very tight stenosis. There was mild-to-moderate atheroma in the right coronary artery.
A single stent was fitted. His echocardiogram showed good left ventricular function with an ejection fraction of 60%. He was discharged home 3 days later.