Ecg contest Response to ECG, February 2019

The electrocardiogram (ECG) (Figure 1), with ST depression and hyperacute T wave in precordial leads, allows the culprit vessel to be located (response 2, incorrect). As described by de Winter et al.¹ in 2008, the ECG indicates acute proximal left anterior descending artery occlusion, as shown in the diagnostic coronary angiogram (Figure 2A, arrow), and so the correct response is answer 4. The ECG does not indicate a subocclusive lesion in the left main coronary artery (response 1, incorrect). In this case, the ECG would usually show diffuse ST depression and ST elevation in aVR.² Likewise, this is not posterior ST-elevation acute coronary syndrome (response 3, incorrect). If it were, the ECG would possibly show ST elevation in the leads corresponding to the inferior face.

Figure 1

Figure 2

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