81 YOM with Chest Heaviness

It’s approximately 2000 hrs, right as you get comfortable in bed, when you are dispatched to a residence for Chest Pain (CP). You arrive on scene to find an 81 year old male, semifowler’s in bed, complaining of chest heaviness, 8/10, which started 2 hours ago, while in bed, watching tv. The patient also advised he has vomited twice since he called 911 less than ten minutes ago.

He is alert and oriented to person, place, time and event, GCS of 15, denies dyspnea with clear bilateral lung sounds, strong and regular radial pulses, warm to touch, diaphoretic and normal skin color.

Medical history:

  • Hypertension (HTN)
  • MI
  • Hyperlipidemia

Medications:

  • ASA
  • Metoprolol
  • Plavix
  • Pravachol

Vital sings:

  • BP: 160/87 mmHg
  • HR: 96 beats/min
  • RR: 18 breaths/min
  • SPo2: 94 RA
  • BGL: 104 mg/dL

You administer O2 at 2lpm via nasal canula and placed him on your cardiac monitor, then obtain the 12 lead ECG shown below:

subendo1edit

  • What is your ECG interpretation?
  • What would be your treatment?
  • Any concerns?

4 Comments

  • Doug says:

    Sinus tach (approx 100bpm) with 1st degree block
    ST depression in leads I, AVL, II with significant ST depression in precordials V2-V6
    Right axis deviation with poor R wake progression.
    Suspect a posterior MI, transmit ECG, obtain IV access, administer 162 mg ASA, nitro, antiemetic ( IV gravol), narcotic pain control ( morphine currently). On route posterior ecg V7-V9 with second transmit, serial ecg’s, vials q 5 mins transporting to a PCI facility. Prep for a potential arrest and dysrhythmias (VT).

  • Eric L says:

    With the diffuse ST depressions significant enough to cause ST elevation in aVR, significant L main disease or 3 vessel disease are likely, and could indicate CABG rather than PCI. In a plavix naive patient, I would consider holding off on loading plavix since the patient might need CABG. I’m not sure what I would do in the case of this patient, who is already on plavix.

  • Alex says:

    1st degree AV block.

    We’ve got ST elevation in the right facing leads (maximal in aVR, some in V1) and ST depression in the left facing leads (I, II, V2-V6) making me think severe 3 vessel disease or proximal LAD or LMCA occlusion but I get very unsure at this point!

    Whichever, it’s not a good ECG to have.

    I would discuss this with the cath lab because I’m unsure how these patients are managed. Do they benefit from bypassing local hospitals to get to PPCI or would they normally be assessed in a local resus room?

  • Reni says:

    Sinus rythm,RBBB,LAFB,ST-depressions I,AVL,V2-V6

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
Comments
CC
80 Year Old Male: Fall
You know.. the story says "suddenly he found himself on the ground, which he attributes to tripping on the runner rug in the hallway." If you want to look at the patient first… an unwitnessed fall with that kind of EKG (long qt in particular) in an 80 year old male who has been on…
2014-08-13 04:02:10
David Baumrind
"Treat the patient not the monitor?"- Redux
Jason, thank you for your comments!
2014-08-11 18:21:02
The LITFL Review 141 - LITFL
Pit Crew CPR – The Explicit Details
[…] CPR? Read about it in a brief post by Tom Bouthillet of the EMS 12-Lead Blog. Tom also outlines the entire pit crew CPR model in this post. […]
2014-08-11 02:36:15
Jason
"Treat the patient not the monitor?"- Redux
David- I agree with your post to a point. I wholeheartedly agree with your frustration at those who post the catch phrase in question when we are discussing ekg's on line in a learning environment. This website has no room for the phrase. Give it your best attempt and read what others have to say.…
2014-08-10 17:45:09
The LITFL Review 135 - LITFL
Revisiting Transcutaneous Cardiac Pacing
[…] familiar with the various presentations of false capture while engaging in the procedure? Check out this detailed post from the EMS 12-Lead Blog. […]
2014-08-10 17:14:07

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