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
Ivan Rios
The role of 12 lead ECG in Pediatric Pulmonary Hypertension
Thanks for writing Tyler. They are the same thing. Strain pattern is just the result of increased pressures against the ventricles which alters the way repolarization occurs from epicardium to endocardium. Similar to stepping on a puddle of water. Your show spreads the water away from the area of pressure. The ST segment is slightly…
2014-12-17 18:44:24
Tyler
The role of 12 lead ECG in Pediatric Pulmonary Hypertension
Can you explain how these ST segment and T wave changes can be differentiated from right strain pattern?
2014-12-17 18:18:25
The role of 12 lead ECG in Pediatric Pulmonary Hypertension | EMS 12 Lead
PULMONARY PRESSURES AND ECG PATTERNS
[…] Pulmonary artery pressures and ECG patterns […]
2014-12-17 17:34:06
EMS 12 Lead
PULMONARY PRESSURES AND ECG PATTERNS
[…] Pulmonary artery pressures and ECG patterns […]
2014-12-17 17:26:42
What it Looks Like: Cardiac Arrest | Think Safe Blog
What it Looks Like: Cardiac Arrest
[…] http://www.ems12lead.com/2014/11/11/sudden-cardiac-arrest/ November 11, 2014 | Original Articles | Vince […]
2014-12-16 16:08:39

STEMI Expert?

  • Click here to find out!
  • 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