A patient with Angina pectoris had a 12 Lead ECG done during a Chest Pain Episode. Which of the following abnormalities will the CHO/Nurse identify in the ECG Report?

Appeared in: Uttarakhand CHO - 2021

Explanation

ST-segment elevation signifies transmural ischemia, where blood flow is compromised through the entire thickness of the heart muscle.
This finding is characteristic of Prinzmetal's (variant) angina, caused by a sudden coronary artery spasm, and is also the hallmark of an ST-Elevation Myocardial Infarction (STEMI).
The provided image clearly displays marked ST-segment elevation, confirming this as the visible abnormality.
Reversible transmural ischemia, such as that from coronary vasospasm (Prinzmetal's angina), can cause transient ST-segment elevations.

Why Other Options Were Wrong

Option A: A prolonged PR interval indicates a delay in the conduction of the electrical impulse from the atria to the ventricles, known as a first-degree AV block. It is not a characteristic sign of myocardial ischemia or angina.
Option B: A widened QRS complex (greater than 120 ms) indicates an intraventricular conduction delay, such as a bundle branch block. It is not a primary indicator of ischemia related to angina.
Option D: Tall, peaked T-waves are the classic ECG sign of hyperkalemia (elevated serum potassium). While T-wave changes can occur in ischemia (hyperacute T-waves can be an early sign), the distinct 'peaked' appearance is most specifically associated with this electrolyte imbalance.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to ECG Interpretation in Angina Pectoris to guide bedside assessment, documentation, and the next nursing action.
A nurse's ability to quickly identify ST-segment elevation on an ECG is critical for patient survival. It signifies a medical emergency (transmural ischemia) that requires immediate intervention to restore blood flow and prevent permanent heart muscle damage.
Upon seeing ST elevation in a patient with chest pain, the nurse must immediately activate the emergency response system or notify the physician, prepare for the MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin), and anticipate urgent transfer for reperfusion therapy (e.g., cardiac catheterization).
What if? If the ECG showed ST-segment depression instead of elevation, the diagnosis would more likely be stable or unstable angina (subendocardial ischemia). While still serious and requiring intervention, the immediate treatment pathway is different from that of a STEMI, often focusing on medical management and less urgent angiography.

How to Approach the Question

First, identify the core of the question: it asks for a specific ECG abnormality seen during an angina episode.
Next, carefully analyze the provided image. The ECG strip clearly shows the ST segment is elevated significantly above the baseline, a finding known as ST-segment elevation.
Evaluate each option in the context of this visual evidence and your knowledge of cardiology.
Recall that a prolonged PR interval relates to AV block, not ischemia.
Remember that a widened QRS complex indicates a bundle branch block.
Recognize that tall, peaked T-waves are a classic sign of hyperkalemia.

Concept Tested & Keywords

Concept Tested: ECG Interpretation in Angina Pectoris
Stem keywords: Angina pectoris, 12 Lead ECG, Chest Pain Episode
Lead-in keywords: abnormalities
Clinical cues: The patient is actively experiencing chest pain, which increases the likelihood of seeing ischemic changes on the ECG.

Question ID

QmBiarZk0W9unuPoh9v3OQ

Reference Book

E6 Medicine Harrison 22e Part 1 p. 1913-1915

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7320-7322

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