40 yo female, thin build with no history/meds/allergies. + smoker. Works as painter outside and was painting when developed pain in her upper chest/left arm which is the same she uses to paint. Also adds that she has been moving and lifting numerous heavy objects over the past week and since then has been having these episodes of shoulder discomfort. Pain is non-radiating with moderate reproducibility with movement and inspiration. I forget what severity scale she gave it but was definitely uncomfortable. Onset was about 3 ½ hours prior to presentation while painting with her trying to work through the pain until it became to unbearable.. Denies nausea, is diaphoretic but has been working outside.
Classic signs and sytoms but supported by stubborness and no this could not happen to me......
ReplyDeleteMy interpretation is angina as evidenced by the myocardial ischaemia in the inferior leads but without further evolution of ST segment changes or positive cardiac enzymes it's not an MI (yet!). Likely to be co-existing with musculoskeletal pain.
ReplyDeleteHow can you say "its not an MI yet"? We cannot disprove the presence of an MI with any 12-lead. You could say "its not a STEMI". That is purely a 12-lead finding.
ReplyDeleteI'm thinking not a STEMI. I don't see ST Elevation in the inferior leads. The T waves do look large and symmetrical though. I always have a tough time w/ symmetry though (though the T Wave of the 2nd complex in II & III land right on a large line). T Waves flipped in V3 & V4 along with some depression in V2 & V3, could this be early findings of a posterior MI?
ReplyDeleteSerial ECGs, O2, NTG, ASA, MS.
Am I on the right track?
There is no evidence of a STEMI here. There is significant ischemia indicated in leads I, aVF, and V1-V4. This 12-lead may represent an early stage in the process of developing a STEMI, but it isn't there quite yet. I would definitely want a 15-lead and another 12-lead in about 5 minutes. Definitely time for MONA and a trip to the ED (give serious consideration to the cath lab - depends on what the serial 12-leads show).
ReplyDeleteIt is important to V3R V4R
ReplyDeletei agree with deastman..
ReplyDelete