Sol Ana Koroneri Tamamen Tıkalı Olan Bir Hastadaki Eğitici Elektrokardiyogram Bulguları

Öz

Belirgin sol ana koroner arter (LMCA) hastalığı ve LMCA’nın total oklüzyonu çok önemli bir kardiyak acil olmakla birlikte acil invazif tedavi stratejilerinin uygulanmasını gerektirir. Ayrıca, bu hastalarda anlamlı derecede daha riskli kateter işlemlerine de dikkat edilmesi gerekir. Tüm bu faktörler, anlamlı LMCA hastalığının tahmin edilmesinde, akut koroner sendromların değerlendirilmesindeki en hızlı ve kolay metot olan elektrokardiyogram (EKG) bulgularının önemini pekiştirir. Bu yazıda, acil servisimize kardiyojenik şok ile komplike olan akut anterior miyokart infarktüsü ile başvuran 52 yaşındaki bir erkek hastanın olgusunu sunmaktayız. Hastanın EKG’sinde sağ dal bloğu, sol anterior hemiblok ile V1-6, D1, aVL ve aVR derivasyonlarında Q dalgaları ve ST elevasyonları ile inferior derivasyonlarda belirgin ST çökmeleri mevcuttu. Koroner anjiyogramda LMCA total tıkalı olmakla birlikte herhangi bir antegrad veya retrograd kollateral akım yoktu.

Anahtar Kelimeler

• Sağ dal bloğu, sol anterior hemiblok, akut koroner sendrom

Educational Electrocardiographic Findings in a Man with a Totally Occluded Left Main Coronary Artery

Öz

Significant left main coronary artery (LMCA) disease and total occlusion of the LMCA are very important cardiovascular emergencies and indicate an urgent need for invasive treatment strategies. Furthermore, a significantly higher risk of catheter-based procedural complications in these patients must be taken into consideration. All of these facts are important issues in estimating significant LMCA disease using electrocardiography (ECG) findings, the fastest and easiest method for the diagnosis and evaluation of acute coronary syndrome. We present here a case report of a 52-year-old man admitted to our emergency department with anterior myocardial infarction complicated by cardiogenic shock. There were Q waves and ST elevations in leads V1-V6, D1, aVL and aVR, as well as marked ST depressions in the inferior leads with right bundle branch block (RBBB) and left anterior fascicular block (LAFB) on the ECG. The left main coronary artery (LMCA) was totally occluded with no antegrade or retrograde coronary flow on coronary angiography

Anahtar Kelimeler

• Right bundle branch block, left anterior fascicular block, acute coronary syndrome

Kaynakça

1. Nikus KC. Acute total occlusion of the left main coronary artery with emphasis on electrocardiographic manifestations. Timely Top Med Cardiovasc Dis 2007; 11: E22.
2. Kosuge M, Kimura K, Ishikawa T, Ebina T, Shimizu T, Hibi K, et al. Predictors of left main or three-vessel disease in patients who have acute coronary syndromes with non-ST-segment elevation. Am J Cardiol 2005; 95: 1366-9. [CrossRef]
3. Yamaji H, Iwasaki K, Kusachi S, Murakami T, Hirami R, Hamamoto H, et al. Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography. ST segment elevation in lead aVR with less ST segment elevation in lead V(1). J Am Coll Cardiol 2001; 38: 1348-54. [CrossRef]
4. Hori T, Kurosawa T, Yoshida M, Yamazoe M, Aizawa Y, Izumi T. Factors predicting mortality in patients after myocardial infarction caused by left main coronary artery occlusion: Significance of ST segment elevation in both aVR and aVL leads. Jpn Heart J 2000; 41: 571-8. [CrossRef]
5. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakamura S, et al. Electrocardiographic features in patients with acute myocardial infarction associated with left main coronary artery occlusion. Heart 2004; 90: 1059-60. [CrossRef]
6. Hirano T, Tsuchiya K, Nishigaki K, Sou K, Kubota T, Ojio S, et al. Clinical features of emergency electrocardiography in patients with acute myocardial infarction caused by left main trunk obstruction. Circ J 2006; 70: 525-9. [CrossRef]