Unexpected find

GorillaMedic

GorillaMedic

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We had a call tonight for a fall—92 y/o F who slipped and fell. Pretty straightforward, right? Well, assessment revealed hip pain with no other injuries; pt has no medical history at all (and overall, seems to be in good shape). Gave her some pain medication and as part of our pain management protocol, placed her on a 4-lead monitor. Surprisingly, she was in sinus arrhythmia with 1st degree AVB! (When we took vitals earlier, her pulse was regular; throughout care, rhythm went back and forth from normal sinus to sinus arrhythmia). Well, i thought that seemed a little odd, so I did a 12-lead and found a significant q-wave in leads V2-5 + aVL, left ventricular hypertrophy, left atrial enlargement, and the previously mentioned rhythm abnormalities.

Reported it to the ED doc and he said he'd let her PCP know that maybe she needs a cardiac workup done.

Not at all what I expected to find, though.
 
92? Not really surprised by any of that. Sinus arrhythmia is bening and fairly common.


B/p? HTN?
 
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Pathological Q waves aren't a common finding but sinus arrhythmia certainly is.

92 years old if you didn't have LAH/LVH id probably think something was wrong.

What are you considering a significant Q wave? I think the criteria for patho Qs is something like 1/3 the R wave of greater? I forget.

If she has no complaints and the cause of her fall was purely mechanical I wouldn't consider a cardiac event outside of her norm.
 
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Something like this?

Q_waves_inf_JPEG.jpg
 
Also what are you going to do about it if she has serious cardiac disease? Maybe start her on ASA and a ACE inhibitor, but she's pretty unlikely to get a stent, or a bypass given her age. I wouldn't even do a stress test. She's 92.
 
I think he just was surprised by the fact that he was called for one thing and found an underlying, totally non related issue.

I think he should be commended, nice catch. I know I probably
Wouldn't have hooked em up to the monitor for a straight forward fall with no LOC or other contributing factors to the fall(dizzy prior, doesn't know why fell)
 
Being surprised by this is particularly concerning to me. What is concerning is the OP claims to be an FP-C yet is surprised by odd EKG findings in a 92 year old.
 
usalsfyre said:
Being surprised by this is particularly concerning to me. What is concerning is the OP claims to be an FP-C yet is surprised by odd EKG findings in a 92 year old.
Click to expand...

Hell, I've got sinus arrhythmia (and sinus pause on occasion too) and I'm the convolution of 92 years (read: 29 years)...
 
My normal PR interval is around .24 so technically I have a 1* AV block.

I hate to see the OP do a 12 lead on me. I also have physiological t wave inversion and left axis deviation.

The patient wasn't complaining of a cardiac problem, so no need to be alarmed.
 
They not infrequently find people in their eighties and nineties with radiographically significant back disorders who have not had complaints, and in one case where a 70-plus year old WWI vet reported in to the VA about back pain, they found an old machine gun slug he had forgotten about which had migrated into a position of discomfort. We adapt and sometimes are ignorantly accepting of stuff others wold have been screaming about years before.
 
I am 24 and have sinus arrhythmia, 1*AVB, LVH, left atrial enlargement, left axis deviation, and BER.

this was all found during my annual physical with Bruce criteria. I got 16 minutes in final step was 6.4mph @ 24*grade. max heart rate was 204. I would say without cardiac complaint don't look for zebras, you wont like what you find. I shouldn't have to tell an "FP-C" this.
 
Whats a 4 lead :unsure:
 
NYMedic828 said:
Whats a 4 lead :unsure:
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The colloquial name for a limb lead system with a separate common ground cable (i.e. RA-white, LA-black, LL-red, and RL-green/common ground).
 
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Christopher said:
The colloquial name for a limb lead system with a separate common ground cable (i.e. RA-white, LA-black, LL-red, and RL-green/common ground).
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<_< I hate you.
 
I remember five-leads with the "gearshift" Burdick machine.
$(KGrHqJ,!g4E-+VE(gi,BQFEm4(2LQ~~60_35.JPG


PS: $300 on Ebay
 
I can't say this surprises me; half the population probably has an undiagnosed arrhythmia, of which I would bet half have AF and the other half have some sort of atrial or atrioventricular conduction abnormality.

I have seen people with AV block, sinus bradycardia, atrial hypertrophy, runs of SVT, PVC's etc and they are for all intents and clinical purposes totally benign.

I recall one young woman who had benign LAH, since we were not transporting her we gave a copy of the 12 lead ECG to give to her GP.
 
My atrial fib went undiagnosed for five years because my MD depended on the software in his machine and despite my worsening condition and complaints. I accepted it ("Occasional PVC", no rhythm strip) and just thought it was part of getting older and out of shape.
 
mycrofft said:
My atrial fib went undiagnosed for five years because my MD depended on the software in his machine and despite my worsening condition and complaints. I accepted it ("Occasional PVC", no rhythm strip) and just thought it was part of getting older and out of shape.
Click to expand...

Not sure which is more concerning; the fact your GP did not interpret your ECG or that your GP's ECG software was not able to pick up AF.
 
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