Onset approximately 1 hour prior to the 9-1-1 call.
No further details of the OPQRST are currently available. I will update the case with this information as soon as it is available, along with the physical exam.
Vital signs:
Resp: 20
Pulse: 56
NIBP: 97/57
SpO2: 100 on RA
Past medical history: HTN
Meds: Unkown
The cardiac monitor is attached.
A 12-lead ECG is captured.
What is your impression?
Would you call a STEMI Alert?
Why or why not?
What additional action(s) might you take?
No, not a STEMI alert, inversion in V1, V2 and V3 says it is not ST elevation, Septal is possible but unlikely.
ReplyDeletePosterior infarct?!
ReplyDeleteST depression anterior leads = ST elevation posteriorly. This is supported by the edging up of the ST segments in the inferior leads. Posterior MI, evolving inferior MI (also supported by the bradycardia). Data from Triton - TIMI 38 does demonstrate that posterior MI is often missed.
ReplyDeleteST depression in L2, L3 & L4. I would go with posterior MI and run a second 12 lead and place lead on the back for 15 lead or a V8 & V9
ReplyDeleteLow BP , bradycardia and ECG
ReplyDeleteAnterior wall MI with RBBB
Dr.Mujeeb
post MI
ReplyDeletejunctional rhythm(retrograde p-wave) + post wall MI. post leads V7 V8 V9 & right precordial leads are neccessary
ReplyDeletest deppression v1-v3 twaves upright ? posterior stemi over 2mm in 2 precordial leads no bbb yet no q's acute posterior mi need R sided or v7 v8 v9 to help diagnose
ReplyDeleteif posterior has met lysis protocol or call in cath lab for rescue
ReplyDeletetall R in V1 for D.D , it may be a post MI but we can rotate the electrode to illusidate it more ( post electrodes), also i cant see P wave it also support the rythm is junctional Rythm ,for cardiac enzymes , troponin level, thyroid function tests,electrolyte tests , start nitrate IV take care of BP, Antiplatlets,heparin, if the cardiac enzyme is high send the patient for cath lab
ReplyDeletethis is a case of junctional bradycardia with bifascicular block with rt ventricular hypertrothy with st segment changes possibly UA or NSTEMI
ReplyDeletethis is a case of junctional bradycardia with bifascicular block with possibly MI
ReplyDeletePosterior MI,would do posterior leads to confirm - send to cath lab if definite STEMI. indeciferable P waves, may be associated with ST depression. also RBBB pattern V6 - observe post PCI
ReplyDelete