Anterior Ischemia or Syncope?

[GoldcrossEMTbasic]

I had a 49 year old female patient who had a syncopal episode at my church, This patient has a HX of elevated lipids and COPD and is on a NC @ 2 Liters per minute on home oxygen. Pt is slightly obese. Pt was just recently put on cholesterol medications. During the service the PT collapsed to the floor and 911 was called and PT was put on 10 LPM Via NRB Mask otherwise all of the measures for a possible cardiac arrest was implemented. On scene I had a cardiologist. Stated that her pulse was next to nothing when the syncope occurred. The Cardiologist wanted a 12 lead done on the pt. However all of the vitals were unremarkable. Pt stated that her O2 sats always ran in the mid 80s, PT states that she recently quit smoking and she states that she started smoking at the age of FIVE! But the ECG tracing showed a Anterior Ischemia on the strip. Normal sinus rhythm. in the 80s and 70s BP was 120/85. And the PT refused to go to hospital. Unfortunately Me and the cardiologist tried to talk to her and convince her that she needed to go to the hospital and get checked out. I was concerned of the 12 lead of what it showed and the cardiologist and I both agreed. And he stated that she may have had an MI or possibly started to go into V-fib. But after the incident she was alert and oriented X3. Can anybody tell me if this was an actual heart attack that she was starting to have or just a syncopal episode? Because this PT has a HX of Hypertension and Takes an extensive amounts of medications, PT is not a Diabetic no AKA. Otherwise HX of respiratory and abnormal elevated lipid profile. :unsure:

 

[Brandon O]

How long was she out? Were there preceding symptoms (lightheadedness, palpitations, aura)? Had she just stood up? Does she have a history of syncope? What do you mean by "anterior ischemia" -- ST depression in anterior leads? What was her sat on scene? Did she have any persistent symptoms? Was this an ALS call or not? What's the administrative capital of Bolivia?

 

[GoldcrossEMTbasic]

She was out for a few seconds, Just lightheadedness and dizziness. We sat her up and did orthostatic BP on her as well that was WNL. Sats were in mid 80s, 12 lead showed normal sinus rhythm but the strip showed a anterior ischemia, I was not sure if ST or VT were depressed or not all I saw was abnormal anterior Ischemia.

 

[VFlutter]

Eh tell her to make an appointment with a Cardiologists and have an Echo and stress test as an outpatient. If she doesn't want to go that is her choice. "Anterior Ischemia" is a vague EKG term. It may not be acute or even accurate.

 

[mycrofft]

Given that data and the description of her reactions and actions, I'd say that there's no way of knowing what happened without seeing and examining the patient.

Which is sort of the basic deal with medical care.

".otherwise all of the measures for a possible cardiac arrest was implemented".

They was? Such as…CPR? AED?

No way to know how recent or important the anterior issue was without labs, especially since her EKG was otherwise essentially normal and she resumed normalcy fairly soon…which people with heat attacks that knock them down rarely do. (About 70% of sudden onset MI's present with clinical death. Just saying..).

With a chronically low pulse-ox reading (question question), could she have fallen out due to positional asphyxia (is she obese?), or gone vaso-vagal (did she stand up suddenly up to a minute before the episode?)?

Maybe this is better in the ALS section.

 

[teedubbyaw]

Eh tell her to make an appointment with a Cardiologists and have an Echo and stress test as an outpatient. If she doesn't want to go that is her choice. "Anterior Ischemia" is a vague EKG term. It may not be acute or even accurate.

Good ol'e anterior ischemia. :dunno:

 

[GoldcrossEMTbasic]

Following up on your response, Yes the PT is obese about 280-320lbs. estimated. PT has Hypercholesterolemia as well just put on medication a week ago. With this type of medical HX Anterior Ischemia is still a possibility. ECGs sometimes are inaccurate, But her pulse dropped to Zero after the syncope occurred, but a few seconds later she regained a pulse. Then was transported routine to the ETC. While enroute all vitals were WNL Monitor showed a sinus 80 BPM. o2 Sats were in mid 80s.

 

[NomadicMedic]

ODHG. Overdose of the Holy Ghost.

 

[GoldcrossEMTbasic]

This what the cardiologist told me when I approached the PT. I have a Scanner APP on my phone. That's how I heard the report to Medical Control. But I agree with you, I think that the cardiologist may have jumped the gun. Because the patient was alert and did not show any chest pain or diaphoresis.

 

[STXmedic]

Wow....

 

[NomadicMedic]

Okay. Let's keep the snark dialed down. This can be a teaching point instead of a "berate the new guy" post.

Remember the first rule is "be nice". I've removed a "not so nice" post already.

 

[teedubbyaw]

This what the cardiologist told me when I approached the PT. I have a Scanner APP on my phone. That's how I heard the report to Medical Control. But I agree with you, I think that the cardiologist may have jumped the gun. Because the patient was alert and did not show any chest pain or diaphoresis.

In other words, you have no training in cardiology and what you say you saw is actually what you were told?

You're throwing us for a loop here.

 

[Medic Tim]

you mentioned she refused then that she was transported???

 

[Handsome Robb]

I'm guessing an ALS crew showed up and did a 12-lead and the printout said "anterior ischemia".

 

[GoldcrossEMTbasic]

Yes the 12 lead did show that. They did it in a private area on scene, not on the rig. The off duty cardiologist ordered the 12 lead. One side of the strip printed normal sinus and then I saw the Anterior Ischemia. Printed on the other side. Used on a Phillips Lifepak.

 

[GoldcrossEMTbasic]

Yes, she was refusing, The medics were wanting to leave, this agency had a really busy day. But It took the pastor and the doctor to get her checked out. Not the ALS crew.

 

[Handsome Robb]

Alright bud. This all makes a lot more sense now.

First off Philips makes the MRx and PhysioControl makes the LifePak.

If I show up on a 911 call and there's a physician on scene they don't order anything. It's my scene unless they want to do everything include riding in to the hospital and writing the report.

There's a reason good medics tear off the machine's interpretation and throw it away or fold it over and ignore it.

We read it ourselves, the machine isn't reliable.

This is one of those cases where you're pretty far over your head bud. We're not gonna be able to tell you more without more information that you're not going to be able to provide.

This isn't an attack on you but a big part of medicine is recognizing when you do need help and don't know something then asking for it. Which it sounds like you did.

 

[Medic Tim]

It is bad practice to use the printout ... Especially if you are ALS. They are usually wrong and give numerous false positives.

So the pt was transported. I think that is what you are saying.... It is difficult to understand some of your posts.

The crew would have ( school have ) done a 12 lead on their own. Where I am it makes no difference who or what the doctor is (unless it is the pts actual doctor) they are a bystander and should not effect my care. Not saying I am going to tell the guy to eff off but in this situation he was really not needed.

 

[Ewok Jerky]

Yes the 12 lead did show that. They did it in a private area on scene, not on the rig. The off duty cardiologist ordered the 12 lead. One side of the strip printed normal sinus and then I saw the Anterior Ischemia. Printed on the other side. Used on a Phillips Lifepak.

#1- "anterior ischemia" is a general term and does not = infarct, STEMI or NSTEMI

#2- A lifepack printout interpretation is NOT a diagnosis. In fact it is sometimes completely WRONG.

#3- I think most of us here would agree that without more information, an H&P or HPI, or actually seeing/talking to the patient, we cannot accurately help you figure this out.

however: if a syncopal episode was her only complaint...no N/V, no CP, no SOB, diaphoresis...then acute MI is unlikely. She could have some underlying ischemia based on any number of things, and "fell out" for any number of other things.

 

[GoldcrossEMTbasic]

The off duty cardiologist told the patient that there is a potential heart issue going on. And he told her that she needed to have further testing done. So to clarify something, if the monitor shows Anterior Ischemia is it a false reading or a confirmed reading? I know what a AI is. It is a lack of o2 to the front part of the heart, due to a blockage possibly atherosclerosis.