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!:
     

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Ruud Valkenborg
Snapshot Case: What Happened?
Beautyfull R on T with a unsynchronised ECV. :-)
2015-05-27 07:38:19
george
Snapshot Case: What Happened?
why cardiovert urgently in this case? The first strip shows a "well controlled" heart rate. Cardioversion provoked torsade de points due to unsync administration....... Unnecessary risk taken......when amiodarone or flecainide would do the job "quietly".....
2015-05-27 06:46:53
Joe
Snapshot Case: What Happened?
Pt has some wicked bi-phasic T-waves s/p defibrillation...
2015-05-27 04:01:32
Greg
Snapshot Case: What Happened?
Unsynced cardioversion! I mirror the comments above wondering why this patient even required cardioversion for this afib as the rate doesn't seem particularly sinister. And after 4 shocks maybe consider that the afib might not respond at all and focus on other treatment avenues.
2015-05-27 02:56:05
Sam
Snapshot Case: What Happened?
The patient appears to have been unintentionally cardioverted during the relative refractory period, which can send the heart into v-fib. The first attempt looks to be 50J, under the 120J usually recommended for rapid a-fib, and did not work. Before the second attempt, it appears that there is no longer capture and the patient was…
2015-05-26 23:51:11

ECG Medical Training

12-Lead ECG Challenge Smartphone App

Photobucket

12-Lead ECG Challenge Smartphone App - $5.99

  • Apple iOS
  • Android
  • Amazon
  • Web Based

  • FRN-TV video review
  • iMedicalApps.com review
  • Interested in resuscitation?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    Visitor Map / Stats

    Locations of visitors to this page


    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS