80 yo femal cp

[pbruss]

80 yo lady with chest pain, pressure, stared 4 hours PTA, makes her SOB and nauseous. ECG is attached, what is you interp and treatment? 

Attachments:

[Bjs04f]

shes paced, so treating it like LBBB, she has significant disconcordant ST in inferior, and modified criteria its >25%ST/T ratio. Also theres an abnormal pacing where the initial pace isnt being captured

[Bjs04f]

So that aspect the 2:1 conduction this may be an dual chamber pacing unit that has encountered a complete heart block and is not conducting a pace, but is v pace

[Bjs04f]

so chest pain, inferior significant modified sgarbossa positive ST, with new av block. need to get intervened on, and also needs if block persists a change in pacer to avoid the atrial pacing, ie single chamber

[pbruss]

you are so right and so wrong. spot on with the discordance. i called cards and told them needed cath but of course they declined. she had a 95% LAD on a cath done 48 hours later because her trops were positive. this pacer, like most all pacers on the market, is an AV dual sequntial pacer. the first pacer spike is the pacer trying to pace the atrium. it waits to see if the artium pace is conducted through and if its not then the ventricular lead fires. that is why the interval between the 2 pacer spike is always the same. so smart yet so foolish stransky.

[pbruss]

i replied to only your first post. now who is the foolish one. i am humbled

[kemple]

inappropriate discordance

[Bjs04f]

humbled by my awesome second and 3rd responses which covered that aspect of the pacing, understanding how it works

[pbruss]

we get it stransky, you are smart. do you feel better now

[Bjs04f]

so much better, been having a lot of dumbass moments recently, needed a W

[tyson]

very impressive bdon

bring that kind of heat for soccer on tuesday.