“Bad heartburn” – Conclusion

Recap In “Bad Heartburn” – 82 y.o. female without chest pain, the paramedic had obtained an ECG on an elderly woman who only complained of mild “heartburn.” An initial ECG was obtained: STE in II, III, aVF, STD in aVL and V2-V4. Also, the T wave is fully inverted in V2 and V3. ECG interpretation : The degree of ST elevation is significantly higher in lead II than lead II, which usually supports an RCA occlusion. Furthermore, there is mild ST depression in lead I, also typical for RCA occlusion. There is apparent sinus arrest, with a junctional escape rhythm, which suggests that the SA nodal artery (usually a branch off the RV) is involved. The ST depression and T wave inversion in V2 and V3 suggest an acute posterior infarct. Grauer’s “mirror test” suggests acute posterion MI. The “classic” pattern of high R waves and upright T waves is actually not representative of acute occlusion – for more on this, read this discussion on old versus “new” teaching on recognizing posterior MIs. We do not see ST elevation in aVR or V1 that would suggest a concomitant RV infarct, however. Patient Course: Although the protocols did not require a computerized interpretation to verify a STEMI, the absence of “typical” ischemic symptoms made a prehospital cath lab activation modestly more difficult to justify. Since the computer interpretation algorithms may miss a STEMI up to half of the time, the medic ob...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Uncategorized Source Type: research