ID: LMFB, 66 years old, female, born and living in Pacatuba – Ceará, Brazil.
Main complaint: “chest pain and shortness of breath”
History of current disease: the patient informed about very intense constrictive precordial pain associated to nausea and vomits with delta-T (ΔT) of 4 hours (ΔT is the time of arrival of each patient to the Emergency Department). She informed about dyspnea to great and moderate strain for the last six months, with worsening after the onset of precordial pain.
Personal pathological history: she mentioned high blood pressure and smoker for a long time. Stroke in 2009 with no sequelae. She denied having Diabetes mellitus, dyslipidemia or other risk factor.
Physical examination: oriented, Glasgow scale 15.
CPA: Split, regular heart rhythm, normal sounds, no murmurs. Systemic blood pressure: 169×78 mmHg, Heart Rate: 104 bpm.
Pulmonary auscultation: vesicular murmur present, with no adventitious sounds. Respiratory rate: 29 rpm.
It is decided to treat her with Primary Percutaneous Coronary Intervention (PPCI) and three stents where implanted.
1. Which is the “culprit” artery and obstruction location? And why?
2. What is the heart rhythm of the first ECG?
3. What is/are the mechanism(s) of P wave alterations?