71 year old male CC: Chest pain – Conclusion

This is the conclusion to 71 year old male CC: Chest pain.

Thanks for all the great comments!

Let’s take another look at the 12-lead ECG.

This 12-lead ECG shows acute anterior ST-elevation myocardial infarction.

Significant ST-elevation is present in leads V2-V5, I and aVL with reciprocal ST-depression in leads III and aVF.

A “STEMI Alert” was called from the field and the ECG was transmitted to the emergency department.

The patient was treated with MONA and the following 12-lead ECGs were recorded en route to the hospital.

The T-waves remain hyperacute but there is significant regression of ST-elevation. Remember, hyperacute T-waves are the best indicator of viable myocardium at risk!

When the paramedics (and their patient) arrived at the hospital the cath team was waiting.

Angiography revealed a 99% occlusion of the LAD. The lesion was crossed with a wire, the balloon inflated, and a stent was successfully placed with TIMI 3 flow restored (successful reperfusion).

After a short stay at the hospital the patient was discharged home.

Discharge diagnosis: ST-elevation myocardial infarction

3 Comments

  • it’s interesting how hyperacute T isn’t as drilled into the heads of providers as STE.

  • Vicki says:

    My friend is a doctor, who graduated from Columbia University’s College of Physicians & Surgeons. Yet he’s always saying he’s “always had trouble interpreting EKGs.”
    He’s not a cardiologist. He worked in ENT and was an Ear, Nose and Throat specialist. But he had to read EKG’s in his intern, and he always went to a cardiologist to get a second opinion.

  • Sandra van WykSandra Van Wyk says:

    ECG is like a language. just need to start at normal and understand what each wave means and picture it. takes time and practise as with any other foreign language you would learn!:
     

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Seth
Conclusion to 59 Year Old Male: Unwell
This was an AWESOME 12 lead. It was a large discussion point for many of my colleagues and I. I look forward to seeing the final conclusion of treatment later on next week. Thanks again for sharing.
2015-07-04 15:19:00
Conclusion to 59 Year Old Male: Unwell | EMS 12 Lead
Conclusion to Snapshot Case: 85yo M – Chest Pain
[…] 3. Uncertain irregular rhythm with RBBB, LAFB, and massive STEMI. ECG reproduced from this case on our […]
2015-07-04 09:23:28
Conclusion to 59 Year Old Male: Unwell | EMS 12 Lead
The 360 Degree Heart – Part II
[…] ST-depression in lead III. For an example with much more subtle ST-deviations check out this case: The 360 Degree Heart – Part II. Since the “high-lateral” territory is poorly covered by the 12-lead ECG, III and aVL […]
2015-07-04 09:10:43
Conclusion to 59 Year Old Male: Unwell | EMS 12 Lead
59 Year Old Male: Unwell
[…] is the conclusion to our latest case, 59 Year Old Male: Unwell. I suggest starting there and reviewing the scenario before diving into this […]
2015-07-04 09:10:24
Jared
59 Year Old Male: Unwell
Field Dx: Uncompensated cardiogenic shock. Tachycardia caused by compensation mechanism. Probable cause: Complete heart block due to the global nature of the changes. Tx: O2 @ 15 lpm NRB and possibly CPAP if pressure rises enough, 324 ASA, amio drip, possible norepi, and diesel. Put pads on in case he tanks. Definitive Tx: Needs cathed.
2015-07-02 17:46:57

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