Acute Anterior STEMI or Left Ventricular Aneurysm? – Conclusion

The conclusion has been moved here:

http://www.ems12lead.com/2011/01/10/81-year-old-male-cc-palpitations/

8 Comments

  • VinceD says:

    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.

  • VinceD says:

    Also, there’s a typo in the sentence under the 12 lead at the top. You refer to it as hypertrophy rather than aneurysm.

  • Tom B says:

    Thank you for brining the error to my attention! It has been corrected.

  • Christopher says:

    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.

  • Tom B says:

    Or carry a flash card! 🙂

  • Christopher says:

    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.

  • Johan says:

    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”).

  • ahmed says:

    very helpful case

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