Found on the LIFENET 03/2011

Let’s presume the chief complaint is chest discomfort.

What do you think?

11 Comments

  • Troy says:

    Inferiolateral MI with reciprical changes in I and aVL. ASA, O2, IV, Nitro, Morphine, Heparin and drive fast! This person needs a cath lab.

    I don’t think its pericarditis because there’s no notched J point, there’s no PR depression, and there’s reciprical changes (which I don’t believe is common but could be wrong)

    I’m guessing LCX occlusion. Serial 12’s en-route

  • Carl says:

    In chest pain, I would make this an ACS.

  • VinceD says:

    Call it. Although the ST-depression and T-wave inversion in aVL looks very much like a secondary change from LVH (I should probably finally commit one of the voltage criteria to memory), the distribution of the elevation across the inferior leads has me sold. The elevation in III and aVF are fairly similar in height, although the size of the QRS complexes differ by about a factor of two. In changes from LVH, I’d expect ST changes proportional to the QRS. Additionally there’s some nice elevation in V4-V6, so I’m saying acute inferolateral MI.

    I’ve never seen a computerized reading of the ST-elevation before, any idea if it calculates at the J-point or J-point plus 60ms? With either criteria some of the numbers seem off… Still handy anyway it appears.

  • William says:

    I would call it an inferior MI and possibly inferiorlateral MI. ST Elevation in II, III, AVF and minor in V5 AND V6. Treat with IV O2 Nitro and Morphine per protocol and get this person to a cardiac hospital for further evaluation and treatment.

    Also lots of artifact in this strip.

  • Jeff C says:

    Inferiolateral Mi with reciprocal changes in leads 1 and AVL. O2, and ASA, I would like to do a 15 lead to see if there were RVI. NTG and transport to PCI center.

  • Christopher says:

    Agreed with all of the above, inferiolateral MI w/ recip changes. I agree with Vince that the ST segments have a weird shape in I/aVL, however, given chest pain this guy gets a STEMI alert.

  • Hank Fackovec says:

    I agree with it being a inferiolateral MI, but I would really look at the BP and perfusion status before giving Nitro. The rate is bradycardic as I would expect, I would also expect to see lower perfusion, contraindicating nitro. I would offer O2, ASA, fluid (As much as his/her lungs can take) to maintain preload, and MAYBE morphine. Then a table for one at Chez PCI.

  • Brandon O says:

    BER with likely inferior MI

  • wasim says:

    its ifero lateral MI with bradycardia,most probably LCX occlusion

  • Brandon O says:

    Having now seen this on a full-sized screen (instead of my phone), I’m leaning toward the inferolateral camp. But what the hell, I’ll stick to my guns.

  • Etty says:

    There’s nothing like the relief of fdining what you’re looking for.

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