Discussion for 51 Year Old Male: Chest Pain

Here is the conclusion to 51 year old male: Chest Pain. You may wish to review the case.

Here is the ECG again:

 

There is a regular sinus rhythm at a rate of about 70. The QRS is narrow. The axis is normal, at about 15 degrees.

Let's take a look at the constellation of ST changes:

There is ST elevation in leads I, aVL, V2-V6. There is slight ST depression in III and aVF (and arguably in lead II) with ugly looking T wave inversions. Some of you also noted the suspicious looking Q waves in III and aVF.

Pericarditis and Early Repol were put forth as possibilities. Remember though, that neither of those will have reciprocal changes (excepting myocarditis, which may present as STEMI). Here, we have reciprocal changes inferiorly. If you were inclined to be thinking about STEMI mimics in this case, those changes should put ischemia at the top of the list.  In addition, as some of you pointed out, the ST changes do not look like Early Repol, and the amount of ST elevation here is alarming.

The crew in this case, along with the physician, decided this was STEMI. The patient was given Heparin, ASA, anti-emetics, and Morphine. His condition improved enroute, and his BP climbed to 124/75.

Upon arrival at the hospital, he was taken directly to the cath lab. There was a complete blockage of the LAD.

 

Here is the cath lab image showing the blockage:

Here is the image after revascularization:

 

I don't know about you, but I always find these images amazing. Fortunately, our patient was discharged from the hospital to cardiac rehab a few days later. He was expected to recover nicely. 

Enjoy the holiday!

 

 

 

 

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Comments
iliyas
Masters Case #01: 50 Year Old Male – Severe Chest Pain
Short runs of V.T LAD LAHB Widespread st depression with St elevation in avr Lf msin / three vessle disease Not sure about rhythm
2015-08-26 06:34:44
Darren Earley
Masters Case #01: 50 Year Old Male – Severe Chest Pain
1. L.A.D 2. De Winters (ST Elevation aVR, ST abnormality V2-3). 3. Non sustained VT 4.Poor quality ECG so cannot say about p waves or whether A.fib. Pre alert for ppci = evolving occlusion of LAD artery. Aspirin. Pain relief. Diesel
2015-08-25 17:26:50
michelle
Masters Case #01: 50 Year Old Male – Severe Chest Pain
first pt. sat's are to low at 94% for just room air pt. needs hi-flow o2 at 15 lt. min. i see a-fib. with runs of 3. st depression. there is also a chance of pheumonia. after o2 administer fluids, a chest x-ray, monitor the heart and ekg especially where bp is low.
2015-08-25 16:57:39
Ivan Rios
Understanding Adenosine (Adenocard)
Correct, even for stress test, with the same purpose.
2015-08-18 17:07:24
Joppe
Understanding Adenosine (Adenocard)
Adenosine is also used to measure FFR in the cathlab to achieve maximum vasodilation in the vessels in the Heart.
2015-08-18 16:02:13

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