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ACES for PACES

Medical Revision

Web ydr.org.uk acesforpaces.com medicalrevision.org

BOF: 2.6

A 56-year-old male presented with crushing central chest pain associated with nausea, vomiting and sweating. His ECG showed ST elevation and T inversion in leads II, III and AVF. He is a known diabetic and has proliferative retinopathy and in view of this thrombolysis was withheld. A few hours later he develops a tachycardia, he becomes hypotensive, his JVP is elevated. On auscultation heart sounds are soft with a fourth heart sound, lung fields are clear. In this patient which of the following leads will show the location to which the infarction has extended?

a)      Lead I

b)      AVL

c)      AVR

d)      V₄ R

e)      V₆

Answer:

d)

The patient presented with an inferior infarction. The clinical features that are obtained when he becomes hypotensive suggest right ventricular infarction , which is indicated by ST segment elevation in the right-sided lead, V₄R.

Myocardial Infarction

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