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Acute Coronary Syndromes

Coronary Artery Lesions at the Same Site Presenting With Different Electrocardiogram Patterns

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To identify the key insights or developments described in this article

1 Credit CME

JAMA Internal Medicine

Published Online: May 2, 2022

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Yanwei Li, MD¹;

Huanlin Zhu, MD²;

Guilan Zhai, MD³

Author Affiliations

¹Chronic Disease Management Centre, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
²Department of Cardiology, The No. 968 Hospital of PLA, Jinzhou, Liaoning, China
³Emergency Department, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China

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A patient in their 30s with a history of hypertension presented to the emergency department with acute chest pain that had begun 4 hours earlier. On examination, the patient’s blood pressure, heart rate, and respiratory rate were 117/78 mm Hg, 88 beats/min, and 20 breaths/min, respectively. A 12-lead electrocardiogram (ECG) was obtained (Figure) at the time of admission. The high-sensitivity troponin I level was 0.155 ng/mL (normal range: <0.034 ng/mL; to convert to μg/L, multiply by 1.0). The B-type natriuretic peptide and serum electrolyte levels were within normal limits. The patient was diagnosed with acute ST-segment elevation myocardial infarction (STEMI) and was immediately transferred to the catheterization laboratory.

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A patient in their 30s with a history of hypertension presented to the emergency department with acute chest pain that had begun 4 hours earlier. On examination, the patient’s blood pressure, heart rate, and respiratory rate were 117/78 mm Hg, 88 beats/min, and 20 breaths/min, respectively. A 12-lead electrocardiogram (ECG) was obtained (Figure) at the time of admission. The high-sensitivity troponin I level was 0.155 ng/mL (normal range: <0.034 ng/mL; to convert to μg/L, multiply by 1.0). The B-type natriuretic peptide and serum electrolyte levels were within normal limits. The patient was diagnosed with acute ST-segment elevation myocardial infarction (STEMI) and was immediately transferred to the catheterization laboratory.

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Article Information

Corresponding Author: Guilan Zhai, MD, Emergency Department, The First Affiliated Hospital of Jinzhou Medical University, Renmin St, Jinzhou, Liaoning 121000, China (zhaiguilan@yeah.net).

Published Online: May 2, 2022. doi:10.1001/jamainternmed.2022.1302

Conflict of Interest Disclosures: None reported.

References

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Littmann L . A new electrocardiographic concept: V1-V2-V3 are not only horizontal, but also frontal plane leads. J Electrocardiol. 2021;66:62-68. doi:10.1016/j.jelectrocard.2021.02.014 PubMed Google Scholar Crossref

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.