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

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Comments
jason
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I'm with Dave Eastman on this. I think it's hyper K+ and will treat as such. But I'll do that will I head to the PCI capable facility. Do I think there is an underlying STEMI? Nope, I sure don't. Do I know the computer has a hard time with false positives? yup. Am I…
2014-09-28 22:15:54
Rodrigo Furtado
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I did forget, is it possible pacer is placed??? sorry that went right over my head.
2014-09-28 20:38:19
Rodrigo Furtado
68 y.o. male with weakness: “Treat the monitor, not the patient?”
1) Change to every lead? STEMI is questionable on my Dx # 6 on a list of 5. IF my recall on this, IF a Global presentation of ST change with QRS Change: a) STEMI is extremely unlikely or NOT STEMI b) start looking for mechanical problems ( tamponade) or chemical/ electrical (electrolyte imbalance or…
2014-09-28 20:34:36
Dave Eastman
68 y.o. male with weakness: “Treat the monitor, not the patient?”
My first thought was hyperkalemia. If the pt is stable, begin with Ca++ & bicarb. Consider albuterol. Serial 12-leads. Start toward PCI capable facility. If it is hyperkalemia, initial treatment should begin to improve pt's condition and there is no harm caused from the increased transport time. If there is an underlying MI as well,…
2014-09-28 18:05:12
Lisa
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Cath lab
2014-09-28 17:29:51

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