Snapshot Case: 44 Year Old Male – Chest Tightness


Here's a new "Snapshot" case courtesy of Dr. Bojana Uzelac from Serbia…

A 44 year old male presents with a chief complaint of tightness in his chest x 1 hour. He was on his way to a conference when it started and states:

"It feels kind of like asthma. I've never been diagnosed but I imagine this is what it would feel like. Maybe I'm just nervous about speaking in front of everyone."

Vitals: HR 85 bpm, RR 20/min, SpO2 97% on room air, BP 157/84 mmHg, and temp 37.1 C.

The patient's skin is cool and dry and he appears mildly anxious. The following EKG is then captured.

2014.02.03 - 0000 - 01 - Bojana Uzelac - Blog Case - EMS 12-Lead

Is this patient experiencing a STEMI? If so, where would his occlusion be located?


8 Comments

  • Shalom says:

    Looks like a STEMI, very probably of the Proximal LAD (Anterior ST elevation with elevation in V1, AVR + possibly Incomplete RBBB)
    Elevation in III makes me think that the LAD may wraparound the apex. (Considering limb leads are properly placed) 

  • ren says:

    I would call STEMI anterior ST elevation. With aVR also being elevated this is a LMCA until proven otherwise (could also be prox LAD).  

  • John says:

    I am thinking pericarditis or possibly BER. I am not calling this STEMI.

  • Joel says:

    Anteroseptal MI with ST elevation in V1-V4, reciprocal depression in Leads I, II, aVL. Likely Proximal LAD occlusion. 

  • sanchopanza says:

    ECG: Sinustachycardia 75/m, normal heart-axis, normale PQ en QTc duration, slight intraventricular conduction delay, significant ST elevation in leads V1-5 and aVR, depression lateral (aVL, V6) and slightly in II, sharp T-waves V2/3.

    Combining this with the complaints and duration (1 hour) I would seriously consider CAG. Possibly proximal LAD/ left main as said by Ren.

    Any cardiovascular riskfactors? Any recent illnesses? (diarrhea, respiratory infection last 2 weeks?)

     

  • Chris says:

    STEMI -anterior.. not sure how any Paramedic can not call this a stemi…. Jon , please explain why you would not call this a stemi?? Chest discomfort-st elevation -new onset . Im hear to learn

  • Matthew says:

    Lots of ST elevation.  To the cath lab!  But maybe pericarditis??

  • P Lem says:

    My quick guess would be Early Repolarization with Hyperkalemia, but tangentially, I'm rather intrigued with the morphology of the anterior lead P waves; is there atrial pathology of some sort as well?

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Kevin
44 year old male CC: Palpitations
Why on earth would you risk VF, by giving Adenosine to rule out rhythms.. This is dangerous, and foolish. There might be a slight chance that this is WPW.. You might as well just give him Cardizem, they are both AV nodal blockers... I don't know why the AHA even added this stupid idea..
2014-10-22 13:31:06
Vince DiGiulio
The 360 Degree Heart – Part II
It is standard practice in electrocardiography to label the first 90 degrees counter-clockwise from "zero" that way. When you see a patient with "left axis deviation" you'll see that their measured QRS axis is somewhere between -30 and -90 degrees. Imagine if you saw someone with a mean QRS axis at 5 degrees. Now imagine…
2014-10-21 14:00:37
Bryan
The 360 Degree Heart – Part II
I don't understand why (-)III and aVL are be labeled -60 and -30 degrees instead of 300 and 330 degrees?
2014-10-21 13:43:29
The 360 Degree Heart – Part II | EMS 12 Lead
The 360 Degree Heart – Part I
[…] first post in our “360 Degree Heart” series attempted to visualize how the different frontal plane […]
2014-10-21 12:50:56
Eric Strong
Axis Determination – Part VI
This is a great discussion of axis determination. One minor suggestion: I think it's potentially misleading to refer to an axis between 0 and -30 as "physiologic left axis deviation", since "axis devitation" implies deviation from normal, and axes between 0 and -30 are perfectly normal, (depending on age and body habitus). It may be…
2014-10-05 17:09:00

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