You are here

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

Title: Normalization of Diffuse ST-Depression with aVR Elevation After Rehydration in a Patient with Severe Aortic Stenosis.
9 views
0 downloads
Name(s): Patel, Sachin R, author
Patel, Vikas J, author
Clark, Brittany, author
Rust, George, author
Type of Resource: text
Genre: Journal Article
Text
Date Issued: 2017-05-22
Physical Form: computer
online resource
Extent: 1 online resource
Language(s): English
Abstract/Description: 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 after cardiac arrest due to massive myocardial infarction. CONCLUSIONS Normalization of diffuse ST depression with isolated aVR ST elevation on electrocardiography with improvement in clinical and hemodynamic status through fluid resuscitation can mask a stuttering myocardial infarction given its association with left main coronary artery disease and partial right coronary artery occlusion.
Identifier: FSU_pmch_28529306 (IID), PMC5447663 (PMCID), 28529306 (RID), 28529306 (EID), 902510 (PII)
Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447663.
Subject(s): Aortic Valve Stenosis/diagnostic imaging
Aortic Valve Stenosis/physiopathology
Coronary Occlusion/diagnostic imaging
Electrocardiography
Fatal Outcome
Fluid Therapy
Heart Arrest/etiology
Humans
Male
Middle Aged
Myocardial Infarction/etiology
Persistent Link to This Record: http://purl.flvc.org/fsu/fd/FSU_pmch_28529306
Host Institution: FSU
Is Part Of: The American journal of case reports.
1941-5923
Issue: vol. 18

Choose the citation style.
Patel, S. R., Patel, V. J., Clark, B., & Rust, G. (2017). Normalization of Diffuse ST-Depression with aVR Elevation After Rehydration in a Patient with Severe Aortic Stenosis. The American Journal Of Case Reports. Retrieved from http://purl.flvc.org/fsu/fd/FSU_pmch_28529306