Cardiac arrest and deep T wave inversions

The paramedic swung the stretcher into the resus bay, and started giving report. As the team of RNs, techs, and residents swung into action, I noted that the young adult patient didn’t look very sick at all. Confused, yes, and perhaps a bit anxious, but this seemed like an over-triage. “Paramedic Battistelli,” I called out, “why is this 38 year-old female patient here, instead of in fast track?” “Hey Dr. Walsh! We were called for a seizure, but she looked fine when we got to the house. She denied any problems, but family said she was just lying on the bed, no warning, when she started convulsing. Vitals and sugar were fine.  Listen, I didn’t think I should call in the cath lab team, but I didn’t like the looks of this.”  And he handed me his 12-lead: “Well.,” I responded, “look at these deep T wave inversions in V1-V4. This looks like Wellens syndrome. We better get the cath lab rolling! When did she stop having chest pain?” “Doc, she denied chest pain, pressure, burning – everything.” “Okay. Then this is probably the anterior T wave inversions you see with a massive pulmonary embolism! We might need to give her tPA. Was she very hypoxic?” “No, in fact she never so much as coughed. No trouble breathing, sats were great.” “Well, it’s kind of rare, but you can see these sorts of inversions with Takotsubo cardiomyopathy too. Let me guess,” I asked loudly, “she must have had a terrible scare right before the seizure. Or maybe...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research