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86 year old female chest Pain STEMI ALERT!

by on April 28, 2011

86 year old female patient sitting at home woke up with substernal chest pain. She had some associated shortness of breath, no n/v. Diaphoresis noted. She stated pain was 8/10 and nothing makes it better or worse. Pt was a poor historian as to her medical history but did state she has HTN, CAD, and cholesterol issues

BP 140/80
P 70
R 18

A 12 lead is obtained and transmitted.

Note the >>>ACUTE MI<<< message circled in Red

The Paramedic running this call stated he gave ASA 324mg and one NTG Spray SL with noted BP drop to 100/60. Bolus of NS was given. V4R was obtained and did not show any elevation. He notified receiving PCI center of STEMI ALERT with 20 minute ETA.

What do you think about this call? Would you have called a STEMI ALERT as well?

From → Case File, Education

  1. I don’t know if on that ECG alone I would call a STEMI. Maybe V3 is concerning, but otherwise looks like a broad RBBB w/ LAFB. The baseline wander in the inferior leads make it look like there is more elevation than I think there really is.

  2. VinceD permalink

    Hmm I don’t think I would call it at this point either, but very likely it’s a heart that’s seen better days at 86 years old with a RBBB+LAFB+1st degree. V1 and V2 have an ugly morphology with an taller R than R’ in V1, which is subjective, but makes me a little extra suspicious. The depression in V2 seems borderline and may be a bit excessive, but it’s tough to tell from this scan of the tracing. The morphology of that t-wave in that lead is also a bit suspicious. With the combination of those three findings, I definitely think posterior leads are warranted and would prefer to have seen them before deciding whether to call a STEMI alert. Her clinical picture certainly doesn’t sound benign, so I’d at least urge her to go to a cath-capable hospital if it’s not too much extra distance.

    On a side note, I’m pretty sure the computer is considering the p-wave as part of the t when calculating the QTi, leading to a falsely elevated reading.

  3. 1 degree, LAD LAFB RBBB – LBBB as well and possible. Posterity wall MI

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