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?

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Jared
59 Year Old Male: Unwell
Field Dx: Uncompensated cardiogenic shock. Tachycardia caused by compensation mechanism. Probable cause: Complete heart block due to the global nature of the changes. Tx: O2 @ 15 lpm NRB and possibly CPAP if pressure rises enough, 324 ASA, amio drip, possible norepi, and diesel. Put pads on in case he tanks. Definitive Tx: Needs cathed.
2015-07-02 17:46:57
Jonas
59 Year Old Male: Unwell
CPAP. IV. Nitro if BP can be controlled. Kidneys may be in acute failure causing extra fluid, or CHF, or both. Big ole triangular looking t-waves would have me thinking calcium. Monitor to see if conditions improve with CPAP. Place pads on patient, and have help with you in the ambulance.
2015-07-02 17:17:30
Brian Brubaker
59 Year Old Male: Unwell
At a quick glance it looks like tombstones (R on T). At closer look without calipers, it appears to be accelerated ideoventricular rhythm due to complete heart block. Not enough information to go off of, so cardioverting or pacing might just kill the patient quicker than anything. Transport immediately since his sick heart could stop…
2015-07-02 05:49:02
Holden
59 Year Old Male: Unwell
I've only studied cardiology for a few months and have read Dubin's book 1.5 times so I'm not an expert by any means. However, can a possible interpretation be a junctional tachycardia with aberrant ventricular conduction and a STEMI? No P waves and aberrancy causing a slightly wide QRS (but not wide enough for V-Tach).
2015-07-02 00:50:22
James
59 Year Old Male: Unwell
This is a ugly EKG. Wide complex irregular tachycardia around 150's. A-fib and a-flutter are possibilities. He's severely symptomatic. At this point, all treatment is same, electricity. If A fib, it may not want to "shock out" easily. This may be a case where initial cardioversion at max joules would be prudent. Pulmonary edema likely…
2015-07-01 22:00:13

ECG Medical Training

12-Lead ECG Challenge Smartphone App

Photobucket

12-Lead ECG Challenge Smartphone App - $5.99

  • Apple iOS
  • Android
  • Amazon
  • Web Based

  • FRN-TV video review
  • iMedicalApps.com review
  • Interested in resuscitation?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    Visitor Map / Stats

    Locations of visitors to this page


    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS