Inferior MI S&S

[Jamie72]

A couple of weeks ago i was on a call with a partner, and on the way back to the 'bus' we were discussing differentials. While there was a possibility it was cardiac in nature (I.E. MI) my partner stated that it was probably an "inferior MI" as in the specific area of the blockage. We didnt have the patient on a monitor of any kind, he just felt that the symptoms pointed in that direction... i dont remember specifics but naseau, radiating pain to the jaw, and weakness were some of the symptoms

Now we both have the same time in the service, and i inquired as to how he knew that, to which he responded "a Dr in the ER told me". I have tried to look up S&S for "inferior MI" and have so far come up with nothing specific. As i am constantly researching things i dont know, i was wondering if any of you could corrolate this info, and if you had a site i could go to to learn a little more.

 

[ResTech]

Signs and symptoms alone cannot tell you which vessels are blocked.

 

[daedalus]

A 12 lead EKG can tell you which part of the heart is suffering from ischemia, injury, or infarct. Clinically, I suppose you might be able to diagnose a large MI's location by pulmonary edema or something suggesting which part of the myocardium is suffering...However, just remember that all chest pain at the BLS level should be assumed to be acute coronary syndrome or other serious condition and treated as such, and that the area of injury will be determined at the hospital after 12 lead and/or angiography.

Without a 12 lead, even acting as a paramedic I will only list possible ACS and treat as such, there will be no "inferior vs lateral wall MI" on my PCR.

 

[Shishkabob]

Every person is different and what may be symptoms fir one person will not be present in the next person with an MI.



Why wasn't a 12lead run?

 

[Akulahawk]

Indeed... IWMI or any other location won't have any specific S & S... unless it's big enough that it causes another problem... but even that won't tell you anything other than "it's BIG".

Without a 12-lead, you just can't really know the location of the MI.

 

[medic_texas]

lol.. Another "know it all" who pulls "knowledge" out of their ***. I love it.

I applaud you for asking the question and researching so you will actually know. Even when people tell you the answer, continue to research until you find the correct answer.

Like someone said, it depends on which vessel is involved. S/S won't tell you anything, even a suspicious 12-lead could be inaccurate, so how would nausea and radiating pain tell you which area of the heart is affected?

I wish I had a copy of this ECG on a patient we had recently. V2-V6 all had significant ST elevation with reciprocal changes in corresponding leads.

Circumflex and LAD were the vessels involved, verified and and ballooned in the cath lab.

 

[Akulahawk]

lol.. Another "know it all" who pulls "knowledge" out of their ***. I love it.

I applaud you for asking the question and researching so you will actually know. Even when people tell you the answer, continue to research until you find the correct answer.

Like someone said, it depends on which vessel is involved. S/S won't tell you anything, even a suspicious 12-lead could be inaccurate, so how would nausea and radiating pain tell you which area of the heart is affected?

I wish I had a copy of this ECG on a patient we had recently. V2-V6 all had significant ST elevation with reciprocal changes in corresponding leads.

Circumflex and LAD were the vessels involved, verified and and ballooned in the cath lab.

I also applaud you for asking the question. The only truly dumb question is the one you don't ask. I give you many kudos for also researching this question on your own. If you have a question, see if you can find the answer. If you can't, ask! When someone gives you an answer, or you see that the general consensus goes a certain way, check into it. Although you may have been given the answer, or the best answer known at the time, by YOU doing the research, you'll learn that for yourself and you'll be a better provider as you'll know the why behind the what... for that question.

 

[daedalus]

Plus you can school that silly partner of yours next time. This reminds me of an EMT who, when asked why he upgraded to a code transport to her ER, said that he noticed the patient devoloped a left bundle branch block midway through transport. This EMT was so good that he could diagnose a BBB by feeling the radial pulse

 

[Akulahawk]

Plus you can school that silly partner of yours next time. This reminds me of an EMT who, when asked why he upgraded to a code transport to her ER, said that he noticed the patient devoloped a left bundle branch block midway through transport. This EMT was so good that he could diagnose a BBB by feeling the radial pulse

That's right up there with opscultating vitals...

 

[Jamie72]

Every person is different and what may be symptoms fir one person will not be present in the next person with an MI.



Why wasn't a 12lead run?

At PCP(Primary Care Paramedic) level in the BC ambulance service we dont do ECG's. That is the realm or our ALS care providers. (Where i work the closest ALS is on the helicopter believe it or not!). Thank you everyone for your responses. Jamie

 

[Akulahawk]

Good to know! If you put in your profile the general area that you work, and your level of training, that helps the rest of us know how to respond appropriately to your situation. Now that we know you're a PCP and your nearest ALS resource is by helo...

 

[cm4short]

From research, an Inferior MI would exhibit symptoms of an MI accompanied with a back-up in the systemic system. In most cases, and Inferior MI is referred to as RVI(right ventricular failure). This is because the failure of the right side leads to reduces preload; thus backs up in the systemic circuit.

Symptoms exhibit a patient who is initially hypertensive, or normotensive. This is accompanied with JVD, peripheral edema, tachycardia and ascites. The key indicators are systemic backup and tachycardia.

 

[taporsnap44]

I was taught that hiccups are a possible sign due to the close proximity to the diaphragm and accompanied irritation.

 

[cm4short]

I was taught that hiccups are a possible sign due to the close proximity to the diaphragm and accompanied irritation.

Joking or serious? Because I've had a few sodas that gave me an AMI

 

[Shishkabob]

I'll have to search for the info to back it up, cm4, but I'm quite confident that only 40% of inferior MI's include the RV, so not all inferior MI's will have peripheral pooling, let alone include the RV.

That's why we look at lead V4R to help. But if you see an inferior MI, it could just be better to assume it include the RV and treat it as such.