Angina pectoris, dyspnea, fatigue, and edema after a non-ST-segment-elevation myocardial infarct
D. Luke Glancy, MD, and William C. Roberts, MD
A 65-year-old man came to the hospital because of retrosternal chest pain, and an electrocardiogram was recorded (Figure 1). It showed sinus tachycardia and ST-segment depression in 8 leads (I, II, aVL, V2-V6) with slight reciprocal ST-segment elevation in lead aVR, findings of severe subendocardial ischemia and/or injury (1, 2). Serum markers confirmed non-ST-segment-elevation myocardial infarction. Despite the development of a systolic cardiac murmur, the patient had an uneventful recovery.
Over the ensuing 8 months, the patient had angina pectoris for the first time and gradually developed exertional dyspnea, fatigue, orthopnea, and marked peripheral edema. He returned to the hospital, and another electrocardiogram was recorded (Figure 2). This one was quite different from the first electrocardiogram. Widespread ST-segment depression was no longer seen. The QRS axis in the frontal plane had shifted from approximately +10 degrees to about +75 degrees. The S wave in lead V1 had shrunk, while the S waves in leads I, aVL, V5, and V6 had increased. T waves were now inverted in leads V1 to V4. These are signs of right ventricular enlargement. |
Baylor Intranet | 
Baylor Portal