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Post by Bjs04f on Apr 23, 2014 16:53:35 GMT -5
55 yo M co chest pain L anterior chest beginning 3 days ago. Seen at urgent care given nitro to go home with. pt states pain occuring more freq and at rest. Pt had episode last night of CP, SOB, N, diaphoresis. Currently mild CP, no other symptoms. Got the Following EKG Doc1.docx (107.44 KB) |
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Post by pbruss on Apr 23, 2014 19:04:51 GMT -5
Very interesting EKG. There is a few worrisome findings on there. I hope we get a lot of input before answer is revealed
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Post by Bjs04f on Apr 25, 2014 11:10:49 GMT -5
anyone.....bueller...bueller?
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Post by pbruss on Apr 25, 2014 16:25:54 GMT -5
IS ANYONE GOING TO GIVE IT A SHOT?
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Post by pbruss on Apr 26, 2014 2:08:36 GMT -5
well, if no one lese is interested i'll gve my interp. here are this things i am worried about: 1. AMI involving proximal LAD with biphasic t waves circled in red 2. PE based on right artial enlargment circled in blue and acute new pulmonary hypertension can cause the t waes circled in red ad well. my managment would depend on his story - good story for ACS:pressure that radiates causing dyspnea and diaphoreses, worse with exertion usually relieved by rest but now constant- then call STEMI good story for PE- sharp, worse with inspiration and movement, high wells score- then i might not call STEMI right away. as an aside- there are some spots that look almost like WPW- short PR with delta wave, but not in all leads and that does not usually cause pain. what happed with patient, im probably way off and he had appendicitis or something like that. Attachments:
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Post by slevittMD on Apr 26, 2014 4:11:17 GMT -5
Possibly Wellens, type 2? I'm not seeing the right atrial enlargement there...those p waves look to be less than 2.5mm to me.
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Post by Bjs04f on Apr 26, 2014 14:56:07 GMT -5
yup so type 2 wellens. the guy went to urgent care with classic AMI symptoms, was given nitro tabs and sent home. came in diaphoretic, worsening chest pain. called cardio to see him, took one look at EKG and pt went to cath lab 100% LAD obstruction.
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Post by mcclain on Apr 26, 2014 18:18:04 GMT -5
I'm too slow to respond to these things. I will try to be quicker! But for this one I was in the department with Stransky anyway so I saw the whole thing.
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nael
New Member
Posts: 2 
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Post by nael on Apr 27, 2014 2:42:41 GMT -5
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