Images in Cardiovascular Medicine
Changing Electrocardiographic Patterns During Medical
Treatment in a Patient With Anomalous Left Coronary
Artery Originating From the Pulmonary Artery
Dona Brekke, DO; Curt G. DeGroff, MD; Michael Schaffer, MD
A
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6-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 day
3 (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.
From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver.
Correspondence to Curt G. DeGroff, MD, Cardiovascular Flow Dynamics Laboratory, UCHSC, The Children’s Hospital, 1056 E 19th Ave, B100,
Denver, CO 80218. E-mail [email protected]
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and
Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute,
6720 Bertner Ave, MC1-267, Houston, TX 77030.
(Circulation. 2001;103:e85-e86.)
© 2001 American Heart Association, Inc.
Circulation is available at http://www.circulationaha.org
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Circulation
April 24, 2001
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Figure 1. ECG from day 1 of presentation in patient with ALCAPA. Typical prominent Q waves are present in lead V6. Conversely, typical abrupt loss of R waves in midprecordial leads and prominent Q waves in leads I and aVL associated with ALCAPA are not present.
Figure 2. ECG of patient on day 3 of presentation after medical management. Typical abrupt loss of R waves in midprecordial leads
associated with ALCAPA is clearly seen. Typical prominent Q waves in leads I and aVL are present. Conversely, typical prominent Q
waves in lead V6 (Figure 1) are not present. Note, Figure 1 is at full standard (10 mm/mV), and Figure 2 is at half standard (5 mm/mV).
Changing Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous
Left Coronary Artery Originating From the Pulmonary Artery
Dona Brekke, Curt G. DeGroff and Michael Schaffer
Circulation. 2001;103:e85-e86
doi: 10.1161/01.CIR.103.16.e85
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