This ECG was recorded in the A & E department from a 55-year-old man who had had chest pain at rest for 6 h. There were no abnormal physical findings, and his plasma troponin level was normal.
What does the trace show, and how would you manage him?
The ECG shows:
- Sinus rhythm, rate 130/min
- Normal axis
- Normal QRS complexes
- ST segment depression – slightly upward-sloping in lead V3, downward-sloping in leads I, VL, V4–V6
This ECG shows anterior and lateral ischaemia without evidence of infarction. Taken with the clinical history, the diagnosis is clearly ‘unstable’ angina.
What to do
There is no evidence that he would benefit from thrombolysis: percutaneous coronary intervention (PCI) would probably be the treatment of choice. Immediately, however, he needs a beta-blocker to bring his heart rate down. Although the normal troponin level suggests that he has not (yet) had a myocardial infarction, in view of the length of the history it would be prudent to treat him with aspirin, heparin and a statin.