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Vol. 73. Issue 3.
Pages 259 (March 2020)
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Vol. 73. Issue 3.
Pages 259 (March 2020)
ECG Contest
DOI: 10.1016/j.rec.2019.10.019
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Response to ECG, February 2020
Respuesta al ECG de febrero de 2020
Pablo Martínez-Vives
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Corresponding author:
, Luis Jesús Jiménez-Borreguero, Fernando Alfonso
Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
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Rev Esp Cardiol. 2020;73:17110.1016/j.rec.2019.08.013
Pablo Martínez-Vives, Luis Jesús Jiménez-Borreguero, Fernando Alfonso
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The electrocardiogram recorded during exercise testing shows a broadening of the final QRS complex over an underlying right bundle-branch block and left axis deviation (a left anterior hemiblock is present). This is indicative of inducible ischemia involving the anterior fascicle of the left bundle branch, and so response 4 is correct. Furthermore, after the performance of single-photon emission computed tomography with methoxy isobutyl isonitrile (SPECT-MIBI), reversible hypoperfusion is observed at the inferolateral wall, consistent with territory damaged by the known coronary artery disease (figure 1). Response 1 is incorrect because significant electrical abnormalities are present. Response 2 is incorrect because spiked T waves in the left precordial leads are a frequent finding in right bundle branch block, without necessarily indicating the presence of inducible ischemia. Response 3 is incorrect because, in presence of right bundle branch block, ST segment depression in the right precordial leads is frequent in the absence of inducible ischemia.

Figure 1
Copyright © 2019. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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