58 yr old male , who was c/o central radiating chest pain, patient found sweating, vomiting , short of breath!
Patient was given 100% 02, 300 mg (Asprin) and rapid transportation to CCU.
Please discuss the features of this 12-Lead Pre-hospital ECG
NB: Below is from the same patient, but the 12 lead ECG was taken 25 minutes later in the CCU department of the local hospital.
Wow... That prehospital EKG is kinda messed up... I don't know what to call it. Some sort of heart block? First or second degree, maybe? ST segment depression, but the prolonged and elevated t-u segment in I, II, III, v3, v4, v5 and v6 made me immediately think ST segment elevation before I took a closer look. Those QRS complexes are awfully narrow, though... Absent p-waves, large, wide u-wave and miniscule t-wave. Actually, the more I look at it, the more normal it seems, outside of the absent p-wave and large u-wave.
ReplyDeleteThe in-hospital EKG looks better, but still no p-wave, normal length QRS complexes, looks like either artifact or atrial fib in I, II, III, aVL, and a short run of a-fib in v4. Plus... Is that the beginning of premature ventricular depolarization in II and v3? Still have those large, flat-top u-waves, I would have to say, based on this EKG, second degree type II av block. That being said, I'm still in pre-med and this is more of a hobby... Here to learn though! So let me know what you guys think...
Oh, and as a side note... Was the patient heamodynamically stable? I'd alert the cath lab and run code 3 if I got that prehospital. NS, possibly nitro or MS depending on vitals and patient condition. Either way, that's one sick heart, N-STEMI?
ReplyDeleteOh... Durrr.... Sorry I forgot about this, but as I said, this is just a hobby. I knew I recognized those huge t-waves elsewhere. LBBB?
ReplyDeleteThe prehospital ECG shows some kind of junctional rhythm with retrograde P-waves, but the most interesting feature is the obvious STMI,antero-lateral, with STE in anterior and lateral leads, and q-waves in v1-v2, avL, and reciprocal STDepression in the inf leads.
ReplyDeleteThe hospital ECG shows in addition the tachycardia (junctional most probably) and the further elevation of the STE, and the q-wave now appearing in v3 also.
The most probable site of occlusion seems to be the left main or proximal LAD.
Thrombolyze or send 2 cath. immediately.
Prognosis: Largely depending on the complications over the next 24-48 hrs.