95 year old female chest pain
EMS called to nursing home for 95-year-old female patient who was having chest pain under her left breast with radiation to left jaw and arm. She stated she was just walking to get some lunch when pain started. She is short of breath and has vomited once. History or Diabetes, CAD, HTN and anxiety. Meds of Lopressor, Humalin insulin and daily ASA.
On exam pt is sitting down and appears sick, she has cool clammy skin and is pale.
Pulse 88 and reg
BP 98/60
RR 16
SP02 88% on room air
12 lead obtained
Repeat 12 lead obtained 25 minutes later at the ER
Treatment and interpretation?
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Septal, anterior, and lateral mi
Acute anterior-septal MI. non-transmural (presence of R wave)
Septal, anterior, lateral MI
Extensive anterior MI, likely LAD occlusion.
I would say acute anterio-septal MI
Anterial, Lateral MI with Inferior recipical changes. But I am not the best at 12 leads.
I agree with the Anterior Septal MI most likely precipitated by LAD occlusion. Although walking to lunch is not really an exercise, the patient is 95 YOA and this could be considered exercise induced which is often associated with LAD coronary artery disease.
Interp:
Nasty. Anteriorseptal STEMI with hyper acute T waves in lateral leads. Many other 12 features. likely LAD occ
Treat:
Load and go, lifeflight if applicable, local ED for possible thrombolitics early notification, rapid transport, start 4lpm 02 NC for low 02, titrate up to 94%SP02, bilateral IV when time permit. Fluid bolus consideration to lung sounds. ASA 324 baby chewable. If I can get BP up with a NS bolus then Id do Nitro drip starting at 10mcg min titrate to systolic BP and or pain relief monitor for signs of trending down. Id hesitate on SL nitro at this time. I find fentanyl to be safe with borderline BP so for additional pain and anxiety 25mcg (Little old lady) then reassess, repeat 12 lead.
Acute extensuve(antero-septo-lateral )MI.
primary survay;rest ,I.V line,O2 inhalation,Aspirin,if sver pain we can give small dose 50ug i.v slowlay and send him for emergent CAG and opening the occlusion(stenting) or CABG ,this according to CAG result during the 90min of pain.