53 YOF with AMS: STEMI or Secondary ST-T Changes?

This is the case of a 53 year old female who presented to the Emergency Department (ED) via EMS, with Altered Mental Status (AMS).

EMS was called to a local dialysis center due to the patient being unresponsive after approximately 3 hours of dialysis.

Upon arrival to the ED, the patient was unable to answer questions, with a Glasgow Coma Scale (GCS) of 8 and the following baseline vital sings:

  • Heart Rate: 74 beats/min, strong and regular

  • Respiratory Rate: 15 breaths/min, adequate tidal volume and regular, with clear sounds

  • Non-invasive Blood Pressure: 202/76 mmHg

  • SpO2: 99% on 15 LPM via Non-rebreather

  • Pupils: 3 mm and reactive to light

  • Blood Glucose Level: 68 mg/dL

Known Medical History:

  • Hypertension (HTN)

  • Chronic Renal Failure

No know allergies.

The following 12 lead ECG was obtained by EMS prior arrival to the ED:

lvh osceola web

(Click on the ECG for a full view)

  • What is your detailed ECG interpretation?
  • What is your treatment?

Click HERE  for the conclusion:

 

 

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Comments
Anne
Adenosine for sinus tachycardia: Try to avoid this!
If it were me, I would seek a second opinion; consult an electrophysiologist. Unlikely that you had sinus tachycardia at that rate.
2015-01-26 09:46:57
John
Adenosine given for a narrow-complex tachycardia over 150
If things such as Sepsis, Drug Use, Medication issues, Anxiety, Pain, etc.. have been ruled out, and the rate is still >160 (or whatever number you use). How else do you determine S-Tach Vs. SVT? Does a 12 Lead Help (QRS Complexes facing different directions due to different pathways etc..) or a simple 4 Lead?…
2015-01-19 19:44:32
Brandon O
Adenosine for sinus tachycardia: Try to avoid this!
She may not have had anxiety, but I bet she was a carrier...
2015-01-18 02:31:08
Brooks Walsh MD
Adenosine for sinus tachycardia: Try to avoid this!
Highly unusual for this to be sinus at that rate!
2015-01-17 19:21:04
Mel
Adenosine for sinus tachycardia: Try to avoid this!
I experience bouts of tachycardia. I had it investigated about 5 years ago after being woken during the night by projectile vomiting and feeling my heart racing/thumping with carotid pulse that I could certainly palpate but had no chance of counting (whether the 2 symptoms were related or coincidental, I don't know). I've had multiple…
2015-01-17 18:47:19

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