81 year old male CC: "Cold and shaky" – Conclusion

Here is the update to 81 year old male CC: “Cold and shaky”

The patient was sent to the cardiac cath lab where angiography revealed 100% occlusion of the right coronary artery (RCA). A stent was successfully placed and the patient is doing well.

Before

Balloon inflation

After successful stent placement

Diagnosis: Acute Inferior ST-Elevation Myocardial Infarction

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Dan
“Bad heartburn” – 82 y.o. female without chest pain.
I'm on board with most of the convents so far. No need to elaborate. I would add maybe a dissection into the aortic root causing RCA occlusion. Not going to know without imaging. Call cath from the field regardless.
2014-08-21 07:41:17
Dan August
“Bad heartburn” – 82 y.o. female without chest pain.
Correction S* and T wave.
2014-08-21 01:53:14
Dan August
“Bad heartburn” – 82 y.o. female without chest pain.
ST elevation in all leads is caused by early repolarization. That's why the Q and T are mashed together. Could be a stemi, but you can't tell with this going on.
2014-08-21 01:51:45
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
Very interesting discussion - I had not anticipated the degree to which giving/not giving nitro would be controversial! I had my own agenda in presenting this case, but I think it would be better to follow the interest of our readers. I'll add a few pearls about ACS, nitro, and inferior STEMIs in my discussion…
2014-08-21 00:14:19
Sassy
“Bad heartburn” – 82 y.o. female without chest pain.
Our local protocols prevent administration of GTN to RVI, Inferior STEMI with BP less than 160 systolic or HR less than 50bpm. As more than 50% of inferior MI's have RV involvement you walk a very fine line between preload and none. The HR could possibly indicate RCA occlusion so there's one side of your…
2014-08-20 22:23:14

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