Conclusion to Masters Case #01

Conclusion: 81 YOM with Chest Heaviness Here’s a visual representation of the ST-vector here in comparison to what we usually see with run-of-the-mill diffuse subendocaridal ischemia and acute epicardial ischemia in the LAD distribution (aka STEMI). Frontal ST-Vectors. Click to enlarge. Transverse ST-Vectors. Click to enlarge. I don’t think the wide-complex beats offer us any additional insight into the ST-changes as they sometimes can, though the morphology in V6 is a bit worrisome. What I mean by that is that the T-waves there are a bit large and feature a rather convex shape. While not diagnostic of anything it’s worth keeping in mind. At this point in my analysis I think it’s safe to say this patient has severe coronary artery disease of some manner. Even before this particular event, from his history alone (obese 50yo M w/ HTN and DM) we probably would have been safe to assume he had coronary artery disease lacking a formal diagnosis. With today’s presentation he sounds very sick and it is clear we should be very concerned about acute coronary syndrome, but what kind? We have to suspect the patient has an acute lesion, but does the EKG support that case and what signs can help us? Well, my first prediction is that the patient is going to have an RCA occlusion on cath. This, however, is not our culprit! Rather, it is an old occlusion from a silent MI some time in the past as evidenced by the Q-wave in lead III with no evidence of ST or T-wave changes the...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-health-safety ems-topics Masters Cases patient-management Training training-development acute anterior STEMI aVR Bojana Uzelac conclusion STEMI Equivalents subendocardial ischemia Vince DiGiulio Source Type: research