It's a snowy afternoon, when you and your partner are called to a local doctor's office for an 89 year old female with "flu-like symptoms", including nausea and vomiting over the past two days.
You walk into Room 2, and find a sick looking woman lying back on the exam bed…She is alert and oriented, and denies any chest pain or shortness of breath…but her color appears grey. She is not diaphoretic, and also denies any numbness or tingling anywhere. She tells you that as long as she lays still, she feels ok, but every time she gets up to walk even a few feet she gets dizzy, short of breath, and nauseous.
She says " I didn't want to go to the doctor, but my friends forced me to because they said I looked ill."
She tells you she's generally in good health, her only hx being very bad hypertension, for which she takes Cozaar and Atenolol. Because of the nausea and "retching", she has not been able to take her meds for the couple of days.
you obtain the following vital signs:
- HR: 44 and regular
- BP: 160/74
- RR: 26 and regular
- Lungs: clear bilaterally
- skin: warm and dry
The PA hands you the following ECG they acquired 30 minutes ago:
You apply your cardiac monitor and acquire the following 12 lead:
Enroute to the hospital, you acquire one more 12 lead:
By request, here are the computerized numbers from the last ECG:
- Vent. rate: 43
- PRI: 0
- QRS: 92 ms
- QTc: 639
- P-R-T axes: 0 -63 -172
How do you interpret these ECG's?
is there anything else you'd like to know?
How will you treat this patient and why?