Tag Archives: STEMI mimics

STEMI Mimics and STEMI Equivalents

Here’s my presentation from the VA EMS Symposium on 11/08/2013. STEMI Equivalents and STEMI Mimics from Tom Bouthillet

The early repolarization experiment

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Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

Discussion for 51 Year Old Male: Chest Pain

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Here is the conclusion to 51 year old male: Chest Pain. You may wish to review the case. Here is the ECG again:   There is a regular sinus rhythm at a rate of about 70. The QRS is narrow. The axis is normal, at about 15 degrees. Let's take a look at the constellation […]

Elderly Female: Chest Pain-Discussion

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This is the discussion for Elderly Female: Chest Pain. You may wish to review the case. Ok, this was not an obvious case, at least, not until the end.  As far as the patient goes, I think we all agree about the differentials: ACS vs. possible aortic dissection (due to the pain radiating to her […]

47 year old female CC: Chest pain – Discussion

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Thanks for all the comments! I’m not allowed to blog while I’m on duty (the policy has nothing to do with me personally) so if it seems like I’m not responding, I’m probably just at work. The paramedic who submitted this case has requested the follow-up information from his supervisor, but unfortunately she’s out-of-town for […]

41 year old male CC: Chest pain – Answer

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Thank you for all of the excellent comments on this case! I was delighted to see such a high level dialog when I checked my blog this morning. Normally I would to answer each of you individually, but since there are 22 comments (so far) I thought I would try a different strategy and post the […]

41 year old male CC: Chest pain

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A 41 year old male is pulled over during morning rush-hour by sheriff’s deputies. He states that he is on his way to the hospital because he is having chest pain. EMS is called to the scene. The patient is awake, alert, and oriented to person, place, time, and event. His skin is pink, warm, […]

PowerPoint Presentation on Strain Patterns!

This is an awesome PowerPoint presentation from one of my favorite ECG textbooks, 12-Lead ECG – The Art of Interpretation. You owe it to yourself to purchase this book (and no, they don’t pay me to say that). Make sure you use “full screen” so you can see all of the features of this important […]

Left ventricular hypertrophy – Part II

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I know I promised to go over the voltage criteria for left ventricular hypertrophy (LVH) but I lied! If you’re really interested you can check out the Wikipedia article HERE, the ECG Learning Center HERE, or Tom Evans’ crib sheet HERE. Personally? I think it’s a distraction. As far as STEMI recognition goes, it misses […]

62 year old male CC: Chest pain

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62 year old male presents to the emergency department complaining of chest discomfort. Past medical history is significant for dyslipidemia and ulcerative colitis. Also prior history of significant tobacco use. Maternal history of CAD. Maternal and paternal history of stroke. The patient’s only medication is Lipitor but he took an aspinin en route to the […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Dominic
Conclusion to 59 Year Old Male: Unwell
Great discussion on a difficult 12lead! I follow these very closely and based on pt presentation and 12lead tracing, this was a difficult or to treat with impending heart failure, hypotension, and trouble breathing. Thanks for the follow up and look forward to next week!
2015-07-06 20:53:35
Billy
Conclusion to 59 Year Old Male: Unwell
Hmmmm, I was fairly close. Sounds like most of the treatment occurred IN Hospital. Love case studies, and that one was good.
2015-07-06 20:28:25
Kori
59 Year Old Male: Unwell
There's the point! There is are no P waves, and the rhythm is irregulary-irregular-atrial fibrillation. If you look, it is rsR phenomen-RBBB, BUT there are huge ST elevations on all leads from V1-V5 (that's why the QRS complexes look so broad). I and aVL is clearly ST elevation suggesting STEMI. In limb leads you can…
2015-07-06 10:12:16
Vince DiGiulio
Conclusion to 59 Year Old Male: Unwell
I'll expand on this in the next post but unfortunately I actually wasn't present for this case so I can't give my direct account of how things happened. That said, from the notes I read and word-of-mouth from those involved (which I suspect painted things in a better light than I would have viewed them),…
2015-07-06 04:09:22
Matt King
Conclusion to 59 Year Old Male: Unwell
Hey Vince thanks for the through follow up with this case. I am curious how his rate was controlled since he was hypotensive and maybe an unknown onset of when his A-Fib stated(thinking anticoagulation first)? As you know the wrong approach could be devastating in this PT with risks of further infarction, stroke, or death…
2015-07-05 14:10:57

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