Changing Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery
A6-month-old child with clinical signs of heart failure and cardiomegaly on chest radiograph was referred for evaluation. An echocardiogram and angiogram demonstrated an anomalous left coronary artery originating from the pulmonary artery (ALCAPA). After 3 days of intensive medical management including intravenous inotropes and diuretics, significant differences were found in the ECGs on the day of admission (Figure 1⇓) versus before surgery on day 3 after admission (Figure 2⇓).
Typical findings on the ECG for patients with ALCAPA have previously been well described. The abrupt loss of the R wave in the midprecordial leads associated with ALCAPA is not seen on the presenting ECG (Figure 1⇓) but is seen on day3 (Figure 2⇓). Prominent Q waves associated with ALCAPA in leads I and aVL are not present in the first ECG (Figure 1⇓); they become prominent, however, on day 3 (Figure 2⇓). Conversely, typical prominent Q waves in lead V6 associated with ALCAPA are evident on the first ECG (Figure 1⇓) but not on the ECG taken on day 3 (Figure 2⇓).
Previous studies have indicated that individual patients with ALCAPA can present with any combination of the findings mentioned. Such ECG changes in the course of medical therapy, however, have not been reported. We speculate that such changes occurred as a result of decreased pulmonary pressures (confirmed by echocardiogram), encouraging a dynamic coronary steal phenomenon.
- Copyright © 2001 by American Heart Association