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ECG
Sept 7, 2015 15:13:58 GMT -5
Post by pbruss on Sept 7, 2015 15:13:58 GMT -5
pt Raj and i had the other day. 56 yo male with htn, DM, no cardiac history with CP that started 30 min ago. describes pain as pressure, with sob and diaphoresis. ECG is attached. what do you think? Attachments:
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ECG
Sept 7, 2015 17:24:49 GMT -5
via mobile
Post by tyson on Sept 7, 2015 17:24:49 GMT -5
Certainly hyperacute T waves in the anterior precordial leads but no diffuse ST depression or AVr elevation that would make me think DeWinter T waves. Probable LAD occlusion is my guess. Obviously serial EKGs. What did the next one show as you are always good for a few ekgs?  I would also get a K+ level, r/o hyperkalemia as those t waves are a little pointy. |
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ECG
Sept 8, 2015 5:26:05 GMT -5
Post by pbruss on Sept 8, 2015 5:26:05 GMT -5
repeat ecg 15 min later. i stat K is 6.2. portable trop in 0.02. what do you think what would you do? Attachments:
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ECG
Sept 8, 2015 6:44:54 GMT -5
Post by tyson on Sept 8, 2015 6:44:54 GMT -5
If i was a little unsure, in knowing that he does not qualify for cath lab at this time and has a K+ that could potentially cause some changes, I would go ahead and treat the K+ and see if there were any changes on EKG. If they resolved, I look for causes of hyperkalemia (renal failure, bleed, spurious, rhabdo, etc...) and treat. If no changes on EKG w/ calcium/insulin, I continue to get EKG's, plan on CVU and hope cardiology will take man for cath emergently.
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ECG
Sept 8, 2015 15:05:39 GMT -5
Post by jpollock on Sept 8, 2015 15:05:39 GMT -5
is the BUN elevated on istat?
very curious about the vital signs, particularly the BP. Is it elevated? thinking of renal failure putting increased stress on heart
I don't always get a ck profile, but I tend to add it in possible renal failure/rhabdo/hyper K situations
I agree with Tyson. I would treat the K and recheck the EKG. it could look a lot more normal, and if worsening it may yet mean a cath lab visit
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ECG
Sept 12, 2015 9:30:36 GMT -5
Post by pbruss on Sept 12, 2015 9:30:36 GMT -5
well we called it a stemi with what looked like de-winter's t waves. we did not believe the ISTAT K as he had focal peaked t waves and some st depression and he had a great story for early infarct. cards came down and canceled the stemi but admitted to the CCU for unstable angina. his official K was normal.
followed up on him and trop climbed to 33 overnight. echo showed hyopkenesis of the left ventricle cath done the next day and had a stent in the LAD.
sorry for the delay but i was waiting for this guys cath report
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