the 100% directionless thread

Peak said:
True, but with the inferior involvement I would also consider either distal RCA or some patients actually have a congenital aberrancy where the posterior descending artery stems off of the RCA (about 10%) and not the LCA (about 70%, about 20% have some degree of origionation from the RCA and LCA).
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At a glance, I don’t even go that deep. There’s an immediate mirrored elevation in II, III and aVF, that alone points to a posterior MI. The rest of the leads with elevation have too many artifacts, for me personally it’s purely academical.
 
Qulevrius said:
At a glance, I don’t even go that deep. There’s an immediate mirrored elevation in II, III and aVF, that alone points to a posterior MI. The rest of the leads with elevation have too many artifacts, for me personally it’s purely academical.
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Sure, I mean this guy is going to get the essentially same workup regardless right?

Personally I love nerding out over some EKGs.
 
@Peak I think you got it mixed up. The posterior descending artery usually branches off the right coronary artery.
 
Aprz said:
@Peak I think you got it mixed up. The posterior descending artery usually branches off the right coronary artery.
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If the vessel branches off of the RCA we typically call it the posterior descending, when it branches off of the LCA it is the circumflex. Aberrant vessel anatomy doesn’t follow the naming we were taught in basic anatomy.
 
Peak said:
If the vessel branches off of the RCA we typically call it the posterior descending, when it branches off of the LCA it is the circumflex. Aberrant vessel anatomy doesn’t follow the naming we were taught in basic anatomy.
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It is my understanding you were talking about where the posterior descending artery branches off of. Usually it branches off the right coronary artery, but sometimes it branches off the left circumflex. In your post, to me, it looks like you're saying it usually branches off the left circumflex instead of the right coronary artery, that it rarely branches off the right coronary artery. That's how I understood your post or interpreted it. This is what looks messed up or reversed to me. If I am mistaken, my bad.

Peak said:
True, but with the inferior involvement I would also consider either distal RCA or some patients actually have a congenital aberrancy where the posterior descending artery stems off of the RCA (about 10%) and not the LCA (about 70%, about 20% have some degree of origionation from the RCA and LCA).
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I believe it should be "RCA (about 70%) and not the LCX (about 10%".
 
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Aprz said:
It is my understanding you were talking about where the posterior descending artery branches off of. Usually it branches off the right coronary artery, but sometimes it branches off the left circumflex. In your post, to me, it looks like you're saying it usually branches off the left circumflex instead of the right coronary artery, that it rarely branches off the right coronary artery. That's how I understood your post or interpreted it. This is what looks messed up or reversed to me. If I am mistaken, my bad.


I believe it should be "RCA (about 70%) and not the LCX (about 10%".
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What I’m referring to is what vessel is the primary cardiac artery which feeds the majority of the posterior wall of the heart.

In normal anatomy (70% of patients) this vessel is the circumflex and originated on the LCA, and the posterior descending is a small vessel that stems off of the distal RCA with a small area of perfusion.

In about 10% of patients the posterior descending is much larger and branches off much more proximal on the RCA and is the primary vessel which perfuses the back side of the heart, and the circumflex is a small vessel with a small area of perfusion.

The remaining 20% have collateral posterior wall circulation that stems off of both the RCA and LCA.

It is difficult to describe because there isn’t a set of names for these vessels when they are different from ‘normal’ anatomy.

Vascular anatomy, whether of the heart or elsewhere, doesn’t always follow the textbook.
 
And those weirdos with a Ramus Intermedius
 
I prefer when that LCA originates on the right coronary sinus.
 
Qulevrius said:
It mirrors in 3 leads, I’d guess posterior.
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Exactly, isn't likely going to change my field management of the patient prior to sending them to the ED/Cath Lab much, if at all. All the rage with posterior/15 lead, sure if there is time maybe, but I want to start transport, get access, get some meds on board, send initial 12 lead and give them a call etc. I'm only one person, and staying and playing for additional time obtaining a posterior and/or 15 leads is wasting time. It's not even a standard for most tertiary cardiac centers, HEMS programs, etc.
 
How does one know that I'm building an AR-15... because theres springs, pins, and detents flying everywhere and plenty of swear words.
 
GMCmedic said:
Stick the lower inside a gallon ziploc when you install the detents and springs. Youre welcome.
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You think by now I'd know tips and tricks like this.
 
Put on my big boy pants and emailed my lender about refinancing the house. Figured I could take some advantage of the Heineken virus and lower my house payments by a couple hundred. I'm told low 3's to high 2's
 
Finally got a pickup time from walmart for groceries. Sunday at 0900......no booze on sunday till 1200.

Sad day. I dont even see the point in getting the groceries now.
 
CALEMT said:
Put on my big boy pants and emailed my lender about refinancing the house. Figured I could take some advantage of the Heineken virus and lower my house payments by a couple hundred. I'm told low 3's to high 2's
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We inquired as well, but costs are high to refinance right now.... Might wait a few more weeks and see what happens.
 
CANMAN said:
We inquired as well, but costs are high to refinance right now.... Might wait a few more weeks and see what happens.
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That’s the one thing I’m worried about. I’m not exactly rolling in the dough at the moment.
 
CANMAN said:
Exactly, isn't likely going to change my field management of the patient prior to sending them to the ED/Cath Lab much, if at all. All the rage with posterior/15 lead, sure if there is time maybe, but I want to start transport, get access, get some meds on board, send initial 12 lead and give them a call etc. I'm only one person, and staying and playing for additional time obtaining a posterior and/or 15 leads is wasting time. It's not even a standard for most tertiary cardiac centers, HEMS programs, etc.
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It is a standard for us, but I thought it was a waste of time. The urgent care had already fired a couple of NTG into her before I got there. I got a line and some fluid/zofran on board and started heading to the cath lab. She was really freaked out. I wish I could have given her a smidge of versed but they lose their mind over the idea of a paramedic giving an anxious patient a benzo.
 
NomadicMedic said:
It is a standard for us, but I thought it was a waste of time. The urgent care had already fired a couple of NTG into her before I got there. I got a line and some fluid/zofran on board and started heading to the cath lab. She was really freaked out. I wish I could have given her a smidge of versed but they lose their mind over the idea of a paramedic giving an anxious patient a benzo.
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Really...? Even if it’s medically appropriate ?
 
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