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This post is an answer to the ECG Case 327

• Rate: 96 bpm
• Regular sinus rhythm
• Normal axis
• ST Depression in all leads except aVL, aVR and V1
• ST Elevation in leads aVR, aVL and V1

The patient’s pain was treated with GTN and IV opiates, alongside a simultaneous blood transfusion. Following the urgent transfusion, the patient’s pain resolved, and the ECG returned to its pain-free baseline. Following a multidisciplinary discussion with cardiology and gastroenterology, the patient was maintained on aspirin, but further anticoagulation was withheld.

He remained pain-free throughout his inpatient stay. Following further transfusion, he underwent an upper GI endoscopy, which revealed a gastric antral ulcer as the source of his GI blood loss. He demonstrated a mild rise in cardiac biomarkers, which was attributed to type 2 myocardial infarction (T2MI) secondary to acute anemia. He is scheduled for an elective myocardial perfusion study as an outpatient.

READ MORE: ECG Interpretation: All you need to know