STEMI Mimics and STEMI Equivalents

Here’s my presentation from the VA EMS Symposium on 11/08/2013.


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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

“Bad heartburn” – 82 y.o. female without chest pain.
I would do a v4r to see if right side involvement as well as posterior v8-v9. Based on the pt not presenting hypotensive this can be RCA occlusion caused by disection of thoracic aortic aneurysm! Debakey type 1 aneurysm! No catch lab however surgical intervention would be required!
2015-10-01 16:47:29
“Bad heartburn” – 82 y.o. female without chest pain.
It's most likely a RVMI because the ischemia/infarction has effected the SA node. IWMI with bradycardia should highly suspect a RVMI. Not all RVMI's are preload dependant. Do a 15 lead ecg to verify V4R elevation. Have 2 IV's established with a bolus of at least 1L of fluid before giving nitrates. If the pt…
2015-10-01 08:55:01
“Bad heartburn” – 82 y.o. female without chest pain.
I kept feading this thread to see how long it'd take for someone to call it as it is 'inferioposterior MI' and the prize goes to iliyas on Sept 11.
2015-10-01 04:08:23
Kevin Dittrich
“Bad heartburn” – 82 y.o. female without chest pain.
S-T (J-Point) elevation in II, III, and AVF are clear. There are no repol abnormalities. There are even reciprocal changes. IV with fluids is a must but beyond that, what else is there. Females, especially, present with atypical symptomologies. Be ready with fluids, but treat with standard AMI protocols. Presentation, ECG, age, sex, it's not…
2015-09-30 13:37:09
“You Make the Call” — 86 Year old Female: Dizzy
There is no LBBB as QRS <120ms. Diagnosing LAHB in a patient with LVH is difficult. ST elevation is appropriate for LVH. 1st degree HB rarely causes symptoms, but when combined with a betablocker could be problematic. I'd want her to have 24 hours telemetry monitoring to rule out cardiac causes of dizziness.
2015-09-29 04:48:04

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