Cardiology Case Report: Intermittent Chest Pain in Older Woman

Author(s):

This case report from Brady Pregerson, MD, features a woman in her mid-80s with a history of ASCVD admitted for intermittent chest pain. Check out the ECG and determine the correct diagnosis!

History:

A patient in their mid-80’s with a history of coronary artery disease (CAD) is sent to the hospital ER by her internist for intermittent chest pain that started a few weeks ago after being essentially chest pain in the 2 years since her last stent. In the past 2-3 weeks she has been having 1-3 episodes of chest pain each day lasting “a few minutes” at a time. She is currently symptom free, with her most recent episode about 3 hours ago. Her triage ECG shows nonspecific changes (not shown).

Exam:

Vital signs are normal. The physical exam is otherwise normal.

You order a repeat ECG during an episode of pain that starts soon after you initially saw her.

Printout of an ECG from patient featured in case report.

Computer Read: NSR at 71, LAFB, ST deviation and moderate T-wave abnormality, consider lateral ischemia

Wht is the most likely cause of the ECG findings in this patient?