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Post by pbruss on Jan 23, 2015 7:18:05 GMT -5
71 yo femal with HTN, CAD, last cath 3 years ago. for the past week she has been dizzy, sob, and weak with exertion. in that time the symptoms have been escalating but not at rest. her son is a paramedic. one hour PTA she called him and said she could not get out of bed. her found her sob and too weak to stand up so he called EMS. currently at rest she denies SOB but says she feels nauseous and dizzy still. denies any vertigo symptoms. vitals - p-65, bp-160/90, t- 37, r -18, 98% on RA. exam is all normal with the exception of rales in the left base. attached is her previous ecg and the ecg done on arrival. what is your interp and treatment plan? does she meat stemi criteria? is the ecg sugestive of any other non-ischemic process? if you could only order one more test to help you out what would it be? Attachments:ecg1.bmp (388.52 KB)
ecg2.bmp (285.77 KB)
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Post by Bjs04f on Jan 23, 2015 15:47:16 GMT -5
Is there a different way to upload these, when you increase pic size it is unreadable
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Post by pbruss on Jan 24, 2015 11:15:29 GMT -5
hope these are better, these is a one MB limit to each attachment so try to get them as big as possible but still under 1MB. is there anything else i can do for you stransky? cup of tea, make you a sandwich, pick up your dry cleaning? Attachments:
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Post by tyson on Jan 25, 2015 18:35:24 GMT -5
lateral stemi?
st elevations in Lead I and AVL with reciprocal changes in III and possibly avf.
the st elevation is not tombstoned as you might expect in stemi, but with reciprocal changes, i think it's okay to call it. heparin bolus.
pick up stransky's dry cleaning on way to cath lab.
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Post by Bjs04f on Jan 25, 2015 20:17:04 GMT -5
Tea would be fantastic, ill sip it while she goes for CTA chest. Looks like BER to me, the AVR depression doesnt count as reciprocal, concave st with terminal qrs slurring seems to lead to BER instead of STEMI. INterestingly enough read a few articles saying that shit isnt benign, but a predictior for increased mortality due to its arrhythmogenic ability in older pt. I bet this lady had a PE though
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Post by tyson on Jan 25, 2015 21:53:33 GMT -5
what would make you say PE? sinus tach? or flipped T's in III?
Why would you have BER in just those two individual leads?
Could always just do an ECHO looking for wall motion abnormality (in case of lateral stemi) or right ventricular strain (in case of PE).
So what is it Dr. Bruss, are you picking up is dry cleaning or getting him tea?
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Post by Bjs04f on Jan 26, 2015 10:04:34 GMT -5
So yeah sinus tach is the most common, but BER can be seen in PE as well, and some of the symptoms shes giving me place PE on the diff. BER can be any segment, anterior, inferior, lateral, with lateral having the worst prognosis. Bedside echo would be awesome especially with the TTH probe look for RV strain. BUt looking at the slurring the concave nature of the ST and how its really minimally elevated looking at T-P segment its maybe 1mm max in those leads
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Post by pbruss on Jan 26, 2015 20:59:01 GMT -5
well played tyson. if you remember my lectures dont forget about repeat EKGs. we did another one 20 min later, see attached. what do you think about the repeat? stransky i will brew you some new tea i have. its called remediation. bitter and hard to get down but i think youll hate it. also i would like one of you two guys to make a new thread. stransky try and convince us that BER is not bening with studies and research if possible. tyson you job is to disprove him. two men enter one ma leaves. intelectual deth match. Attachments:
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Post by Bjs04f on Jan 27, 2015 11:12:09 GMT -5
Did this lady go to cath. The new one has more of an ischemic patter, but the first still has a very Ber morphology. I'll post the Ber stuff in a new thread
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Post by Bjs04f on Jan 27, 2015 11:49:44 GMT -5
I think I might just take Ber out of my vocab. Let cardiology call it that if they want.
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Post by kemple on Jan 27, 2015 15:15:44 GMT -5
How was your tea Stransky?
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Post by pbruss on Jan 27, 2015 16:13:03 GMT -5
went to cath have not seen report yet
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Post by Bjs04f on Jan 27, 2015 16:41:42 GMT -5
How was your tea Stransky? tasted like a shit sandwhich, thought I was getting pretty awesome looking at theses damn things, catching subtleties. Nope got too fancy, need to get back to COlyer basics its either a stemi or its not |
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Post by tyson on Jan 27, 2015 18:22:52 GMT -5
it's okay stransky, I was batting 0/40 on brusses cases until this one. finally got to first base.
i love boobs (that's first base, right?)
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Post by kemple on Jan 28, 2015 13:19:07 GMT -5
Sorry buddy no boobies for you.
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