Here's a great case submitted by a faithful reader who wishes to remain anonymous.
On arrival patient is found sitting on his living room couch. He appears anxious and acutely ill.
He states that he was riding his bike when he became anxious, had a "coughing spell" and started to experience chest discomfort. The location of the chest discomfort is in the center of his chest and slightly to the left.
Onset: Sudden while riding a bike
Provoke: Nothing makes the pain better or worse
Quality: Difficult to describe but with prompting the patient calls it "pressure"
Radiate: Left jaw and left arm
Severity: 7/10
Time: No previous episodes
The patients skin is warm and moist. The color is normal.
The patient denies shortness of breath. Breath sounds are clear bilaterally.
He is nauseated but he has not vomited.
Past medical history: Healthy
Medications: None
Vital signs are assessed.
Resp: 22
Pulse: 98
BP: 140/84
SpO2: 100 with oxygen via NRB @ 15 LPM
The cardiac monitor is attached.
A 12-lead ECG is captured.
What is your impression?
*** Update 05/14/2010 ***
The importance of serial ECGs cannot be over-emphasized.
In this case, a second 12-lead ECG was captured just prior to arrival at the hospital.
Does this new information shed any light on the probably diagnosis?
What else could you have done?
*** Update 05/14/2010 ***
The importance of serial ECGs cannot be over-emphasized.
In this case, a second 12-lead ECG was captured just prior to arrival at the hospital.
Does this new information shed any light on the probably diagnosis?
What else could you have done?
The guy has MI InferoLateral. Which pay prognose to PAF paroxysmal Atrial Fibrilation while undergoing treament in Hospital for Acute MI..
ReplyDeletePosterior Wall MI no?
ReplyDeletethe rythem showed progressive lengthening of PR interval and follow by drop beat..suggestive of 2*AV Block mobitz type 1 (winkenbech)
ReplyDeletethe 12 lead ECG upon arrival in hospital showed ST depression in lead V1,v2,v3,v4. his vital sign normal.
my imp : stable angina with anterioseptum ischemia.
sorry..my imp: stable angina with anterior ischemia
ReplyDeleteI second what Jaha has said about the Mobitz type I block, but I think it is imperative to take a V4R view to check for posterior MI which if negative one proceeds to manage as a case of anteroseptal ischemia. H Sabir.
ReplyDeleteECG looks like posterior MI, possibly inferior also - particularly with Mobitz I. I agree - check V4R. But I also wonder if it is a red herring in a 26 year old ...
ReplyDelete