# MI presentation



## MonkeyArrow (Aug 2, 2015)

Had this case the other day in the hospital. 46 y/o male drove himself to the ED after complaining of intense pain in the left arm starting approximately 1 hour ago. Initial 12 lead out at triage showed 1 mm of ST elevation in leads III and aVF. (sorry, don't have the actual ECG but not really the point of this scenario) No reciprocal depression. Some isolated T-wave inversion in I, aVL, and V4. Patient denied any past pertinent history, no known history of diabetes, hypertension, hyperlipidemia. No medications. Right sided 12 showed 1 mm of elevation in V4, V5, and V6. Did end up getting taken to the cath lab.

With this specific presentation on ECG, what is the associated patient complaint you would expect?


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## Aprz (Aug 3, 2015)

It sounds like you are describing ECG signs of an inferior wall infarct with right ventricular involvement due to right coronary artery occlusion. Occlusion of the right coronary artery is likely to lead to hypotension, sensitivity to nitroglycerin, nausea/vomiting, and bradycardic arrhythmias such as a second or third degree block in addition to other signs of cardiac ischemia such as chest discomfort, shortness of breath, and poor skin signs.


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## MonkeyArrow (Aug 3, 2015)

Well, I guess that was a poorly worded exercise. But yes, I was going for nausea/vomiting. The cardiology PA came down and said N/V is a pretty specific presentation for inferior MI. 

Also, a good reminder to look at the whole patient and not the 12 lead. Had you looked at the 12 lead, Sbargrossa criteria may not have been met and you would have missed a STEMI.


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## STXmedic (Aug 3, 2015)

MonkeyArrow said:


> Also, a good reminder to look at the whole patient and not the 12 lead. Had you looked at the 12 lead, Sbargrossa criteria may not have been met and you would have missed a STEMI.


Was there a LBBB?


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## chaz90 (Aug 3, 2015)

MonkeyArrow said:


> Well, I guess that was a poorly worded exercise. But yes, I was going for nausea/vomiting. The cardiology PA came down and said N/V is a pretty specific presentation for inferior MI.
> 
> Also, a good reminder to look at the whole patient and not the 12 lead. Had you looked at the 12 lead, Sbargrossa criteria may not have been met and you would have missed a STEMI.


Hmm. Sgarbossa criteria only apply to paced rhythms or LBBB, so I'm a bit confused as to where that came in. 

Either way, if I have a patient that has ST elevation in inferior leads I'm absolutely doing a right sided EKG, even in the field. Cool scenario.


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## MonkeyArrow (Aug 3, 2015)

My bad. I don't know what I was thinking when I typed that. No LBBB. I meant he barely would have met standard STEMI activation criteria of 1 mm in 2 contiguous leads.


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## Ewok Jerky (Aug 3, 2015)

Not for the astute clinician!


MonkeyArrow said:


> I meant he barely would have met standard STEMI activation criteria of 1 mm in 2 contiguous leads.


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