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Post by erwoody on Jul 17, 2015 12:16:51 GMT -5
54yom patient presents with nausea, belching mid-sternal epigastric pain. H/O smoking, htn. Typically antacids work..this time they didn't.  Was given GI cocktail and is asymptomatic requesting discharge go home. |
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Post by erwoody on Jul 17, 2015 12:17:12 GMT -5
seen in express care. brought me the ECG
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Post by erwoody on Jul 17, 2015 12:17:29 GMT -5
ok to send home?
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Post by DD on Jul 17, 2015 12:32:29 GMT -5
Got an old? Don't like the flipped Ts in aVL
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Post by erwoody on Jul 17, 2015 12:33:24 GMT -5
didn't have one
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Post by DD on Jul 17, 2015 12:43:29 GMT -5
Probably work him up. Abnormal ECG is abnormal ECG.
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Post by tyson on Jul 17, 2015 13:23:23 GMT -5
agreed. flipped T in AVL is always abnormal. Also, some subtle planar st depressions in lateral leads of V5, V6. Maybe even a touch in lead I. see if he wants a cath with that GI cocktail?
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Post by erwoody on Jul 17, 2015 13:39:56 GMT -5
Excellent. The presence of reciprocal changes in AVL is bad. Usually AVL T-waves are flat or slightly upright. (although inverted T in AVL CAN be a normal variant with LBBB and LVH with a strain pattern). This guy actually had a recurrance of his pain about 30 min after initial eval/ecg so the ECG was repeated.  he progressed to his infarct and went to cath lab. |
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Post by pbruss on Jul 18, 2015 5:21:08 GMT -5
amal mattu says that inverted t wave in AVL is the first sign of RCA occlusion, that if you were tie off hte RCA the first and only thing you would see in Inversion in AVL. how long had this episode been going on for? and good cathc by the express doc
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Was given GI cocktail and is asymptomatic requesting discharge go home. 
