Silent MI

[Christopher]

We had a pt the other day that had a "silent MI" ie no chest pain.

If a tree falls in the woods, and a paramedic is not around, does it make a sound? Do you still board and collar it? You can ignore me now...

"Silent MI" is a layperson term in the same vein as: "they had a heart attack and had to have CPR and defibulamation".

Awful term with respect to getting the patient appropriate treatment. Not blaming you or anything, but it is worth throwing out of your vocabulary.

 

[Christopher]

Thanks for the discussion. Like I said, I'm a basic and I only have basic EKG knowledge. I've never attended an ACLS class or a 12 lead class.

Lots of good resources online thankfully.

The system I work in is very weird to say the least. The protocols make many medics scared to do anything but drive code 3 to the ED.

I die a little inside whenever I read about this. Thankfully it seems you care enough so that when you become a paramedic you'll buck the trend!

The treatment done were: IV, O2, monitor, ASA, and eventually zofran. The lead medic didn't really want to even give that.

Fairly reasonable treatments. As you noted this is basically the bare minimum required.

Also, no R sided EKG performed.

I'm on board with not getting a R-sided ECG on this patient. Anterior ST-elevation with inferior ST-depression is statistically not likely to involve the RV or posterior wall, so you add little diagnostic information with the addition of R- and Posterior-leads.

ST-elevation in III > II, with reciprocal depression in aVL, with changes in V1 can prompt Rt sided views. Although, again you can "infer" the possibility of RVMI and ensure adequate fluid support prior to NTG.

Isolated ST-depression in V1-V3 with isoelectric or elevated ST-segments in V6 should prompt posterior views.

It just frustrates my partner and I because we always want to do more for the patient.

As they say in baseball, "welcome to The Show."

 

[kindofafireguy]

I'm not a fan of the term silent MI. I think it is too vague and has become a catchphrase for any AMI with atypical presentation. I feel that in the majority of cases the signs or symptoms are there in a "silent MI" but are veing misinterpreted or ignored, either by the provider or patient.