ECG Strip

[NPO]

What is your interpretation and treatment plan for the following patient?

45 y/o Male, family member called 911 because the pt wasn't feeling normal. Upon arrival pt states he has a headache and "just doesn't feel good for the past two hours. He also states he feels like his heart is acting funny, but denies chest pain. Also states he has some mild difficulty breathing. Initially pt wants to AMA.

HX: Asthma
Meds: Albuterol
No Allergies
BP: 112/68 (following BPs were inconsistent as low as 68/40 and high as 130/90)

Pt later states he took some Albuterol for the breathing ptoblem, no improvement.

Pt placed on monitor and lead aVf was noted to be suspect so 12-lead was obtained and transmitted. See below.

 

[NPO]

Double post.

 

[teedubbyaw]

Apical MI or pericarditis...

 

[Rialaigh]

Pericarditis sounds good to me.

Depending on length of time you are with patient I would be curious as to repeat EKG's over the next hour or two, to see if things resolve or worsen from a 12 lead standpoint. My guess is this guy gets one night on an obs unit, labs are normal, discharged with follow up, and at the follow up his EKG looks great.

 

[NPO]

Pericarditis sounds good to me.

Depending on length of time you are with patient I would be curious as to repeat EKG's over the next hour or two, to see if things resolve or worsen from a 12 lead standpoint. My guess is this guy gets one night on an obs unit, labs are normal, discharged with follow up, and at the follow up his EKG looks great.

Initial 12 lead on scene said AMI. Repeats en route said ST abnormality, and ST elevation possibly due to early repol.

ER did not immediately activate Cath upon transmission or upon er arrival.

I will follow up with the MD and post the outcome.

 

[teedubbyaw]

Why are we caring what the machine says?

He needs more assessment to move me in one direction, but the reciprocal changes I'm seeing for leads II, III & AVF are suspicious to me.

 

[NPO]

Why are we caring what the machine says?

He needs more assessment to move me in one direction, but the reciprocal changes I'm seeing for leads II, III & AVF are suspicious to me.

I'm just letting you know what the doc in the box thinks. There was no differences between the 12 leads.

 

[teedubbyaw]

Did you get a temp? Any pain at all? Was he sticking to a certain position? Shallow breathing?

A varying BP could coincide with pericarditis (or be incorrect readings), the fairly acute onset, not so much.

 

[Aprz]

Doesn't look like anything to me personally.

 

[NPO]

Did you get a temp? Any pain at all? Was he sticking to a certain position? Shallow breathing?

A varying BP could coincide with pericarditis (or be incorrect readings), the fairly acute onset, not so much.

Didnt get a temp, but I dont recall anything abnormal when I sat him down (hot/cold) and color was normal and was dry. He couldnt really specify where he felt weird. Just waived his hand over his chest. Breathing wasnt too shallow.

 

[teedubbyaw]

Doesn't look like anything to me personally.

I thought the same initially, but looking closer, the subtle global ST elevation, PR depression, possible pathological Q wave in AVL (can't tell), reciprocal changes, and the patient presentation -- something is going on.

 

[tpchristifulli]

I see elevation in inferior leads with reciprocal changes. I do believe pt could have some early repolarization due to LVH.
With fluctuating pressures that low I would like to see a 15 lead and do a "medication investigation " to see if he has been taking any new medications. Blood sugar, temp and heart sounds will help as well. Heart Valve infection is likely as well.

 

[STXmedic]

I see PR depression more than I see ST elevation.

 

[tpchristifulli]

I see PR depression more than I see ST elevation.

I see what you mean, you use the T-P interval as a baseline?

 

[STXmedic]

I see what you mean, you use the T-P interval as a baseline?

Yes. And the TP seems to align nicely with the ST segment.

 

[Christopher]

What is your interpretation and treatment plan for the following patient?

45 y/o Male, family member called 911 because the pt wasn't feeling normal. Upon arrival pt states he has a headache and "just doesn't feel good for the past two hours. He also states he feels like his heart is acting funny, but denies chest pain. Also states he has some mild difficulty breathing. Initially pt wants to AMA.

HX: Asthma
Meds: Albuterol
No Allergies
BP: 112/68 (following BPs were inconsistent as low as 68/40 and high as 130/90)

Pt later states he took some Albuterol for the breathing ptoblem, no improvement.

Pt placed on monitor and lead aVf was noted to be suspect so 12-lead was obtained and transmitted. See below.

SR, otherwise normal ECG. aVL has rs rather than qs complexes, so I don't think that is anything to worry about. PR-depression is present, although I find that unlikely to suggest pericarditis in this case. I measure ST-elevation from the PR-segment, but find the elevation present to not be suggestive of ACS.

If serial ECG's trended in any way I'd update my diagnosis, but ultimately that looks like an unremarkable 12-Lead.

 

[Redneck]

sure there is ST elevation in II, III, and aVF. where do you see reciprocal changes?

 

[teedubbyaw]

AVL has pretty clear depression. Subtle depression in I.

 

[Clare]

Pericarditis usually presents with atypical or global ST elevation. It is usually also worse with posturing the patient. I see no evidence of either.

Need more information as to what was found O/E.

 

[captaindepth]

What is your interpretation and treatment plan for the following patient?

45 y/o Male, family member called 911 because the pt wasn't feeling normal. Upon arrival pt states he has a headache and "just doesn't feel good for the past two hours. He also states he feels like his heart is acting funny, but denies chest pain. Also states he has some mild difficulty breathing. Initially pt wants to AMA.

HX: Asthma
Meds: Albuterol
No Allergies
BP: 112/68 (following BPs were inconsistent as low as 68/40 and high as 130/90)

Pt later states he took some Albuterol for the breathing ptoblem, no improvement.

Pt placed on monitor and lead aVf was noted to be suspect so 12-lead was obtained and transmitted. See below.

Just a thought but what about something to do with the RAA. The P-waves are clearly peaked and approx 2.5mm tall in lead II. The pt initially complains of difficulty breathing and does have a respiratory history. Maybe a small PE or some other pulmonary origin of the event.