Conclusion to 83 Year Old Male: Shortness of Breath

Last week we presented the ECG of a patient experiencing progressively worsening shortness-of-breath over the course of a day and some marked ECG abnormalities. If you haven’t done so already, it would probably be a good idea to check out the original post first. Strap in, this is going to be a thorough discussion. Here again is the patient’s initial ECG: Not a STEMI-equivalent. This ECG shows: Sinus tachycardia at a rate of 96 bpm. First-degree AV-block (PRi of approx 240 ms). Left anterior fascicular block (LAFB), resulting in… Left axis deviation (mean frontal QRS axis approx -60 degrees), and… Persistent large S-waves in V5 and V6. Old anterior infarction (Q-waves in V1-V3, almost no R-wave in V4). Moderate ST/T-wave abnormalities in a pattern of diffuse subendocardial ischemia. ST-depression in I, II, aVL, aVF, V3-V6; ST-elevation in aVR, V1. Frontal ST-vector of approx 200 degrees, towards the right shoulder. The #1 take-away from this case is that this ECG is not a STEMI-equivalent. STEMI’s need immediate revascularization and, except in some specific cases, their first stop should be the cath lab. Diffuse subendocardial ischemia is quite the opposite in that it should usually be managed medically in the ED first. Only after initial stabilization and evaluation will select cases proceed to near-immediate or early catheterization. It has been a popular topic of ECG teaching for the past few years but diffuse ST-depression with ST-elev...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Cases aVR LMCA occlusion ST-elevation in lead aVR subendocardial ischemia Vince DiGiulio Source Type: research