PMC7391081_01
12-lead electrocardiogram (ECG) obtained at the time of arrival of the patient to the ED. ECG shows diffuse T wave inversions (blue arrows) and ST depressions in V3, V4, V5, and V6 (red arrows).
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On initial ECG in the ED, the patient was found to have ischemic changes with diffuse T wave inversions and ST depressions in V3, V4, V5, and V6 (Figure 1), and the cardiac troponin I (cTnI) was elevated to 0.06 ng/ml (reference range 0-0.03 ng/ml).
Patient's ECG three days before starting chemotherapy. ECG is normal with no ST segment or T wave abnormalities.
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Of note, patient had ECG done during his regular visit to primary care physician three days before starting chemotherapy which was completely normal (Figure 2).
Patient's ECG after 2 hours from arrival to the ED. ECG shows new ST elevations on lead 1, V3, V4, and V5 (red arrows).
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Two hours later after arrival to the ED, ECG showed new ST elevations on lead 1, V3, V4, and V5 (Figure 3).
Pictures of emergent coronary angiogram after patient's arrival to the ED. Pictures show only mild focal left anterior descending artery disease.
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The patient was taken for an emergent coronary angiogram which revealed mild to moderate proximal left anterior descending artery disease with no acute occlusion (Figure 4).
Patient's ECG after 6 hours of hospitalization. ECG shows that T waves are normalized in most of the leads, but it still remains inverted in lead II, III, aVF (blue arrows).
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T wave abnormalities (Figures 5 and 6), troponin started to trend down and chest pain resolved in 24 hours. Two days later, the patient was discharged with normal ECG (Figure 7).
Patient's ECG after 24 hours of hospitalization. CG shows that T waves are normalized in most of the leads and there are no ST segment abnormalities.
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T wave abnormalities (Figures 5 and 6), troponin started to trend down and chest pain resolved in 24 hours. Two days later, the patient was discharged with normal ECG (Figure 7).
Patient's ECG on discharge ECG is normal with no T wave or ST segment abnormalities.
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T wave abnormalities (Figures 5 and 6), troponin started to trend down and chest pain resolved in 24 hours. Two days later, the patient was discharged with normal ECG (Figure 7).