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

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Comments
Tim
The most awesome STEMI test on the internet!
Thanks for the app. It made me think about all that one may see in the field. The only problem was I never got a score or saw the results of how I did other than saying I had completed the test. Anyway a great way to get the old brain working.
2014-10-30 13:14:27
Brian
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Dustin
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I see a very sick and complicated patient. 12 Lead: ST elevation in AVR and V1 along with depression in I, II, V4-V6 leading me to an LMCA occlusion. The tall R wave in V2 also points me to Posterior involvement. Posterior MIs and LMCA occlusions can and do cause pulmonary edema, which this patient…
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Adrian
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