ECG case series for paramedics: October 2023

This 32-year-old lady normally keeps fit and well. She delivered a healthy baby boy by caesarean section 10 days ago following an uncomplicated pregnancy. She has maintained good health throughout her life.

This morning while breastfeeding her baby, she felt acutely unwell. She felt a tightening pressure developing within her chest over several minutes. She was very sweaty and frightened. Her husband immediately called for an ambulance. The ECG in Figure 1 was taken.

She was triaged to the catheterisation laboratory for emergency primary percutaneous coronary intervention.

The diagnosis at coronary angiography was of spontaneous coronary artery dissection (SCAD) of the proximal left anterior descending coronary artery.

SCAD is an uncommon non-atherosclerotic cause of heart attack. Rupture of the intimal layer of the coronary artery allows blood between the middle and inner layers resulting in the development of haematoma within the tunica media, leading to separation of the intima. Haematoma from the false lumen that is formed compresses the true lumen and restricts blood flow.