The conclusion has been moved here:
Very interesting case. I had read (maybe even in Dr. Smith’s book) that the T-waves of LVA tended to be lower than those of acute STEMI, but I had never seen a method with possible cut-offs of the proportions to aid with the diagnosis.
I agree it definitely looked “new” as opposed to “old,” but being not just pain free, but symptom free, for 24 hours did a lot to confuse the picture. Had this patient walked into triage at my hospital (not PCI capable), I know it might have been very difficult to get him transferred for same-day PCI, let alone emergent revascularization as a STEMI. Do you have any information on how the call was handled (STEMI alert or not) or how rapidly the patient got to the cath lab? Thanks a ton for the great teaching you do on this site.
Also, there’s a typo in the sentence under the 12 lead at the top. You refer to it as hypertrophy rather than aneurysm.
Thank you for brining the error to my attention! It has been corrected.
I think the important part of this one was the PMD stating there were “changes”.
“Could I see the prior ECG and could you make a copy for me.”
Good case, although now I have to commit another formula to memory from Dr. Smith! Pretty soon I’m going to have to dust off my multivariate calculus books to read a 12-Lead.
Or carry a flash card! 🙂
Hah, that’s exactly what sits behind my accountability tag, 12-Lead flash cards! If I ever fall out they’re going to know I’m allergic to PCN and have too much free time on my hands.
To VinceD :
I think that it can not be considered as a direct alert case(symptom free for 24 hours), but I can not see any Q-waves so I think that acute PCI would be the case (“there is myocardium to save”).
very helpful case
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