Angioplasty with Bezold-Jarisch Reflex

From the blog of Dr. Wes, check out this BBC news video of a STEMI patient receiving angioplasty. Interesting that he could localize his pain and the quality was “sharp” as opposed to dull. It just goes to show the limitations of the OPQRST for ACS patients. I’m assuming it was the RCA as reperfusion seems to have triggered a run of VT.

Acute inferior STEMI often presents with sinus bradycardia due to the Bezold-Jarisch reflex (or less commonly direct ischemia of the SA node) but anyone who works in the cath lab will tell you that sudden reperfusion of the RCA triggers the reflex in a more dramatic fashion, sometimes putting the patient into VF.

After watching it twice, I noticed that the cardiologist is looking at what appears to be a prehospital 12 lead ECG! Apparently it’s not necessary to repeat the 12 lead ECG in the emergency department after all!


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