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Conclusion: 86 year old female chest Pain STEMI ALERT!

by on April 29, 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?

Here is the conclusion to this case

Not much to tell here. This ecg gave a message of ***ACUTE MI*** I have heard it is protocol for some systems to treat and transport as a STEMI when that message is given. But as it has been pointed out this ecg alone is not enough to pull the trigger on calling a STEMI. The EMS crew arrived at the receiving hospital and the patient was placed in an ER room. The on duty ER Doctor told the attending paramedic that he thought it was just “age related ecg changes.” The patient was treated and released and was not a candidate for the cath team.

From → Case File, Education

  1. Interesting case.

    As a relatively bright young man mentioned previously, the most problematic lead is V3 which shows concordant ST-depression.

    However (and this is original research) I have noticed that with bifascicular blocks in particular, when the terminal deflection transitions from positive to negative in the precordial leads, it can be associated with a concordant T-wave in the lead above or below the transition.

    You’ll notice that in lead V2 the terminal deflection is positive. In lead V3 the terminal deflection is almost isoelectric (but depressed). I believe that when this happens the secondary T-wave abnormality from lead V2 (which is appropriately discordant) “follows” the transition to the next lead.

    You will notice that by lead V4 the terminal deflection is fully negative and the T-wave becomes positive (appropriately discordant).

    Cool case!


  2. Hello i have to say thanks so much this data brought to us was so important, i indeed enjoyed every piece of this information it has absolutely helped me.

  3. J. Forsyth permalink

    Looking at it, I wouldn’t have gone Code with this, I would’ve definitely treated it though. Saying its age related changes makes no sense I guess that means that everyone gets some sort of block when they get older then huh? That BP drop just reminds me why I always start a 18 or bigger before I give NTG every time.. Nice Site Jeff

  4. judy from florida permalink

    I have a strip for you but it is saved on my phone. I can send it to to look at and give all the info if you would Like? Let me Know?

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