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
Comments
“Bad heartburn” – Conclusion | EMS 12 Lead
63 year old male CC: Substernal Chest Pain – Discussion
[…] upright T waves is actually not representative of acute occlusion – for more on this, read this discussion on old versus “new” teaching on recognizing posterior MIs. We do not see ST elevation in aVR or V1 that would suggest a concomitant RV infarct, […]
2014-08-22 16:49:18
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
Why give atropine at this time?
2014-08-22 15:42:18
Bryan Laviolette
“Bad heartburn” – 82 y.o. female without chest pain.
In addition to the above treatment consensus (ASA, Plavix, judicious NTG, fentanyl, fluid bolus, right sided leads), I would absolutely transport this patient to a PCI centre. Culprit artery is the RCA (STE lead III > II) leading to AV nodal ischemia and junctional bradycardia. In addition to the above treatment I would give 0.5…
2014-08-22 13:14:35
Jared
“Bad heartburn” – 82 y.o. female without chest pain.
Not much to add but my 2 cents...I'd definitely be careful with the nitro, not saying withhold it completely but absolutely use some common sense. I'd have to say probably RCA occlusion, and catch team needs to be activated for a stemi alert immediately. Treat it like a stemi until proven otherwise. If it walks…
2014-08-22 08:49:36
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
The option was indeed turned on! As for non-CP presentations of ACS, I absolutely believe that these warrant the same level of urgency as the "typical" presentations. Both men and women, young and old, all commonly present without classic chest pain. Besides, how much difference is there between "burning in the epigastrium," and "pain in…
2014-08-21 17:10:37

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