A Stroke of Bad (Pot)luck

ANSWER

The correct interpretation includes normal sinus rhythm, acute ST elevation anterior myocardial infarction (STEMI), and inferolateral injury. Sinus rhythm is signified by a P wave for every QRS complex and a QRS complex for every P wave at a rate between 60 and 100 beats/min.

A STEMI is defined as new ST elevations at the J point in at least two contiguous leads—in women, 1.5 mm in leads V2 and V3 and 1 mm in all other leads; in men, 2 mm (those 40 and older) or 2.5 mm (those younger than 40) in leads V₂ and V₃ and 1 mm in all other leads. The anterior location is evidenced by the significant Q waves in leads I, V₂, V₃, and V₄. T-wave inversions in these leads are absent due to the STEMI.

Inferolateral injury is identified by the Q waves in leads I, aVL, V₅, and V₆. Pseudo Q waves are seen in leads II, III, and aVF.

Troponin levels were significant for an acute myocardial infarction (MI). Cardiac cauterization confirmed an occlusion of the proximal left anterior descending coronary artery, and significant stenosis of the first obtuse marginal branch of the circumflex coronary artery. The patient’s lack of chest pain represents a common presentation of an MI in women, particularly those with a history of diabetes.