Here's an interesting case study from a faithful reader from Ann Arbor, MI who wishes to remain anonymous.
Chief complaint: SOB and Chest pressure constant 9/10 which woke her from sleep. Pt also vomited when she woke up and hands tingle. No radiation and nothing makes pain better or worse.
Medical history: Triple bypass x 2 years, Renal Failure, HTN, High cholesterol, Diabetic type 2, family hx of MI, constant vertigo.
Medications: Zoloft, Lisinopril, Rengel, Plaquenil, Levothroid, Plavix, Sodium Bicarb, Coreg, Nephro, Prilosec, ASA, Norco, Leverin, Novalog.
Allergies: Codine, Toradal
- HR 77
- BP 143/84
- RR 18
- BGL 298
- Skin PWD, Cap-refill >0.2sec
12-lead ECGs are captured about 30 minutes apart.
- Denies HA or nausea
- Eyes: PERAL
- BS: Clear x4, chest = rise/fall, SAT 100 on 6lp NC, speaking full sentences, breathing non-labored
- ABD: No c/o pain soft non-tender x4, with no rigidity.
- No edema noted
- Amputation above knee L-leg
- Smoker, quit x 8 years
What do you think about the 12-lead ECGs?
What is the most likely cause of the ST-depression and T-wave inversion?