A 40 year old man presents to the emergency department with a history of chest pain two hours previously. He is now pain free.
a. Describe and interpret her ECG (50%) b. What investigations does this man need and why? (50%)
FACEM VAQ Exam 2005.2 – Question 7
- Overall pass rate for this question was 36/56 (64.3%).
- The ECG provided shows a change from broad to narrow complex rhythm across the ECG and ST/T changes suggesting a proximal LAD stenosis.
- The key to this question was to recognize ECG changes strongly indicative of a proximal left coronary stenosis which was visible in the second half of the ECG when the broad complex rhythm was no longer present.
- Candidates who failed did not appreciate the clinical significance of the ECG changes and the presumed site of stenosis, and therefore did not make clear the need for early angiography.