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Soru

Zorluk: Çok zorCardiovascular System

Match each patient's presenting electrocardiographic (ECG) pattern and clinical scenario with the most likely corresponding underlying coronary artery pathology or myocardial injury.

  • A patient with recently resolved angina; ECG reveals deep, symmetrically inverted T waves in leads V2 and V3 with preserved R-wave progression and no Q waves.Critical stenosis of the proximal left anterior descending (LAD) artery
  • A patient in cardiogenic shock; ECG demonstrates 2-mm ST-segment elevation in lead aVR accompanied by widespread ST-segment depression in six other leads.Severe left main coronary artery (LMCA) stenosis or diffuse three-vessel disease
  • A patient with acute ischemic chest pain; ECG shows horizontal ST-segment depression, tall R waves, and prominent upright T waves in leads V1 through V3.Acute transmural infarction of the posterior wall of the left ventricle
  • A patient with severe chest pressure and diaphoresis; ECG shows ST-segment elevation in leads I, aVL, V5, and V6 with reciprocal ST-segment depression in leads II, III, and aVF.Acute transmural infarction of the lateral wall of the left ventricle

Cevap

The correct matches map Wellens syndrome to critical proximal LAD stenosis, diffuse ST depression with aVR elevation to Left Main or three-vessel disease, V1-V3 ST depression with tall R waves to Posterior wall infarction, and lateral ST elevations to Lateral wall infarction.
Each specific ECG pattern directly maps to a distinct anatomic location of coronary occlusion or myocardial territory ischemia, relying on the spatial representation of the standard 12 leads and recognized high-risk eponymous syndromes.

Adım Adım Çözüm

1
Analyze the ECG findings for the patient with resolved angina and deeply inverted T waves in V2-V3.
This pattern identifies Wellens syndrome.
Wellens syndrome represents a critical, highly unstable stenosis of the proximal LAD that can rapidly progress to an extensive anterior STEMI.
2
Evaluate the ECG showing ST elevation in aVR with widespread ST depression.
This indicates global subendocardial ischemia.
Global ischemia with aVR elevation strongly points to a severe left main coronary artery (LMCA) occlusion or severe triple-vessel disease, which frequently presents with severe hemodynamic compromise or cardiogenic shock.
3
Interpret the horizontal ST-segment depression and tall R waves in V1-V3 during acute chest pain.
This is the reciprocal manifestation of an acute posterior STEMI.
Because the standard 12-lead ECG lacks posterior leads, a posterior transmural infarction is viewed invertedly through the anterior leads, turning typical ST elevation into ST depression.
4
Identify the territory of ST-segment elevation in leads I, aVL, V5, and V6.
These are the lateral leads, indicating a lateral wall infarction.
Infarction of the lateral left ventricular wall produces ST elevation in these leads, typically secondary to occlusion of the left circumflex artery or a diagonal branch of the LAD.

Anahtar Kavram

Advanced 12-lead ECG interpretation of acute coronary syndromes, specifically identifying high-risk ischemic patterns (Wellens syndrome, Left Main occlusion) and localizing transmural infarctions (Posterior, Lateral).
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Cardiovascular System

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