Case Report: Bigeminy with Alternating Injury Pattern Morphologies in a Young Woman After Cardiac Arrest

Introduction: Coronary artery disease is uncommon in adults under the age of 35, and studies show a lower incidence in women of this age group. Physicians should suspect myocardial infarction in all patients who present with cardiac arrest and a shockable rhythm. Case Report: We report a case of a 34-year-old female who presented after return of spontaneous circulation following both pulseless electrical activity and ventricular fibrillation. The initial emergency department 12-lead electrocardiogram (ECG) demonstrated ST-segment elevation in the anterior precordial leads. The second, more notable, ECG showed a unique ischemic pattern of ventricular bigeminy with each beat containing a different morphology of injury pattern. Emergent cardiac catheterization found a 100% occlusion of the proximal left anterior descending artery. Conclusion: Premature ventricular (or junctional) contractions can indicate ischemia when the morphology consists of excessive discordance between the QRS complex and the ST segment and T wave. This case illustrates the importance of scrutinizing each beat in every lead to increase sensitivity for ischemia.