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Update – 61 year old male chest pain

by on August 22, 2011

Here is an update for 61 year old male chest pain

The initial 12 lead EKG

Just 21 minutes later the urgent care obtained another 12 lead EKG

The first EKG showed some subtle ST elevation in the inferior leads with reciprocal changes in leads I and AVL.

The second EKG shows an obvious inferioposterior STEMI with probable RVI as well.

Urgent care staff did start Chest Pain protocols and started an IV of normal saline and gave ASA 324mg, NTG and 5mg MS while awaiting EMS to arrive. This patient was transported to a PCI center and taken straight to the Cath Lab. No 15 lead obtained.

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From → Case File, Education

2 Comments
  1. Anonymous permalink

    I Know he is having a STEMI, but am not sure if it is just an Inferior STEMI with all of the other leads that show depression. I would like a 15 lead and maybe he is having a LAD STEMI, is there reciprocal changes or old ischemia with all of that that appears to be depression.

    BR

  2. BR,

    When you have inferior changes and the ST-elevation is higher in III than in II, that usually indicates the RCA is the culprit. Adding our reciprocal changes in I/aVL/V1-V4, this looks consistent with an inferior MI with posterior extension.

    My guess would be a culprit RCA prior to where the posterior wall is fed (i.e. right dominance).

    I would agree that a 15-Lead view would be helpful, as we should have a high index of suspicion for both posterior and right sided involvement!

    Does this help?

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