51 YO Female chest pain
51 Yo female patient c/0 chest pain that radiates to her left arm. She stated pain is 8/10 “feels like and elephant is sitting on me.” She is short of breath and diaphoretic, lungs are clear and equal. She states nothing makes her pain better or worse, She has taken her daily ASA. She is anxious and crying. History of HTN, anxiety, CAD. No allergies. She stated she takes medication for her med hx but does not know the names of them.
12 lead obtained and V/S obtained
Respiration 22
BP 110/50
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Inferior + posterior (maybe also + lateral, slight STE in V6) STEMI, AF.
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St. Elevation
Maybe Brady, or a fib Stemi
View leads II and III closely you will see a short run of A-Flutter after the third cardiac-cycle.
In A-Fib the fibrillation waves wont have the same morphology because of multiple pacemaker sites in the atriums. A-Flutter will have the same morphology as seen in these two leads.
In V1 possible A-Fib; in the rest of the precordial leads there is a U-Wave after each cardiac-cycle. In elderly patient U-Waves are important to identify especially if they are discordanant the T-Wave. The importance of the U-Wave and the opposite direction is that it can indicate a left main occlusion in elderly patients.