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, and moist.
He appears acutely ill and anxious.
He states that he has a history of high blood pressure and renal insufficiency. He takes several medications, but he can only recall that one of them is a beta blocker.
Onset: 1 hour ago while sleeping.
Provoke: Nothing makes the pain better or worse.
Quality: Patient describes the pain as a poorly localized "fullness" or "pressure".
Radiate: The patient cannot tell whether or not the pain radiates.
Severity: The patient reluctantly gives the pain a 7/10.
Time: The patient states he has had the pain on several occasions over the past few months but did not seek medical treatment.
Vital signs are assessed.
Resp: 20
Pulse: 76
BP: 138/78
SpO2: 99 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
What is your analysis of this ECG?
Does anything about it concern you?
Is this a STEMI?
Why or why not?
Note: This 12-lead ECG was captured in the back of an ambulance with the motor and generator running, but it shows excellent data quality.
Severe 3-vessel disease generally presents with widespread ST-segment depression
ReplyDeleteexcept in aVR and V1, where ST elevation is seen which is more pronounced in lead V1.
All other leads are not depressed, and V2 is elevated, so it may also only be a septal infarct. I would still be weary of a 3-vessel disease though.
STEMI posterior MI as indicated by ST-segment elevation in V2 and V2
ReplyDeleteThere left axis deviation and left venricular strain prominent in V2
There ischemic changes in the lateral leads indicating impending NSTEMI lateral MI
Also there is ischemic changes in lead II , III and AVF indicating impending NSTEMI inferior MI
So, till this point there ST-segment elevation posterior MI with non-ST-segment elevation lateral and inferior MI,so we have 3-vessel disease.
Do posterior infarcts not rather result in a reciprocal ST depression in lead V1 & V2?
ReplyDeleteI can't see any of the inferior ST changes being >1mm... However, you may be right in this sense by the reciprocal ST depression in the high lateral leads.
Who can tell us exactly where the lesions are in 3-vessel disease? And how treatable it is? (I understand it has a very high mortality rate). Thrombolytics?
Did anyone make to this patiant a right leeds?
ReplyDeleteI have a reason to say suspect right MI cuse we see akevation in V1 and AVR and dipration in V6
and inversio T wave in I and AVL
I agree with Richardt and suggest a Septal STEMI although highly suggestive of LMS disease with AVR and V1 elevated. Angiography would be best option to see what was going on.
ReplyDelete3 vessels disease usually trerated with cabg..
ReplyDeletenot likely thrombolytics..
I can't see clear ST elevation ,ok there is ST depression in lateral lead.but we can note that there is hyperacute T wave in ant lead, so we nead to do serial ecg to see the changes.
ReplyDeleteit could be STEMI.