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

JEMS Talk: Google Hangout

Comments
iliyas
Masters Case #01: 50 Year Old Male – Severe Chest Pain
Short runs of V.T LAD LAHB Widespread st depression with St elevation in avr Lf msin / three vessle disease Not sure about rhythm
2015-08-26 06:34:44
Darren Earley
Masters Case #01: 50 Year Old Male – Severe Chest Pain
1. L.A.D 2. De Winters (ST Elevation aVR, ST abnormality V2-3). 3. Non sustained VT 4.Poor quality ECG so cannot say about p waves or whether A.fib. Pre alert for ppci = evolving occlusion of LAD artery. Aspirin. Pain relief. Diesel
2015-08-25 17:26:50
michelle
Masters Case #01: 50 Year Old Male – Severe Chest Pain
first pt. sat's are to low at 94% for just room air pt. needs hi-flow o2 at 15 lt. min. i see a-fib. with runs of 3. st depression. there is also a chance of pheumonia. after o2 administer fluids, a chest x-ray, monitor the heart and ekg especially where bp is low.
2015-08-25 16:57:39
Ivan Rios
Understanding Adenosine (Adenocard)
Correct, even for stress test, with the same purpose.
2015-08-18 17:07:24
Joppe
Understanding Adenosine (Adenocard)
Adenosine is also used to measure FFR in the cathlab to achieve maximum vasodilation in the vessels in the Heart.
2015-08-18 16:02:13

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?

    Interested in Advanced Cardiac Life Support?

    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