On arrival the patient is found sitting on the couch. She appears acutely ill.
Skin is pale and diaphoretic.
Onset: 1 hour ago
Provoke: Nothing makes the pain feel better or worse
Quality: Heaviness or pressure
Radiate: Pain radiates to neck and jaw
Severity: 7/10 and persistent
Time: No previous episodes
Past medical history: HTN, dyslipidemia, breast CA
Medications: Unknown
The patient admits to mild dyspnea but breath sounds are clear.
Vital signs are assessed.
RR: 18
Pulse: 96
BP: 172/72
SpO2: 98 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
Displeased with the data quality, paramedics capture another 12-lead ECG.
What do you think is wrong with this patient?
it looks like inferior MI, there is also ST depression in lead v2 and v3.
ReplyDeleteAcute inferior MI. Systolic hypertension. Occasional premature ventricular complexes.
ReplyDeleteInferior MI is obvious, then, with high probability of extension to the posterior wall of LE, because: the specifically "ST depression image" in V1 and V2,(and V3 has slightly the same image, too) and the ST elevation is higher in DIII, then aVF and finally DII, which supports the probability of oclusion of RCA and by that, there's a high chance of extension to the posterior wall or/and the right ventricule. Right precordial leads V3R to at least V6R should be done!
ReplyDelete*posterior wall of LV
ReplyDeleteP.S. the systolic hypertension maybe it's normal, because of the high sympathetic stimulation in, and, the dyastolic blood pressure it's perfectly good, so, maybe shouldn't be a big concern...I suppose.
acute inferior MI
ReplyDelete