A 65 years old male came to the ED with complain of retrosternal chest pain and breathlessness. Patient is known diabetic since 15 years. His ECG is displayed below.
O/E
B.P - 80/60 mmHg
H.R - 50/min
What Should be the next step in the management of this patient?
Hello Readers, Thanks for your valuable comments. I am publishing the best Interpretation Given by Ken Grauer, MD of ECG Interpretation .
Interesting 12-lead tracing (though a bit difficult to make out given suboptimal quality). Nevertheless - there is sinus bradycardia at ~50/minute with 1st degree AV block and complete LBBB. In addition - there is definite inferior ST elevatation (lead III > II) - with reciprocal ST depression in aVL. In addition - there are primary ST changes in V4,V5,V6 - all suggesting a proximal RCA lesion in a patient with a left-dominant circulation - so urgent PCI in this hypotensive patient large evolving acute MI. Pacing may soon be needed (complete LBBB plus 1st degree). VERY INTERESTING tracing - THANKS for posting!
For anyone interested in a user-friendly guide for determining what is the likely culprit artery (as well as likely conduction defects from various MIs) - GO TO: https://www.kg-ekgpress.com/ecg_-_coronary_anatomy-mi_localization/
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RV infarct
ReplyDeleteAttach IV 0.9% saline , shift to cath lab for Primary PCI
first degree AV block,inferior wall infarct
ReplyDeleteAgree with above. MI protocol i am still a sucker for O2, low flow ok 1-2 LPM NC
ReplyDeleteInferior MI for primary angioplasty
ReplyDeleteInteresting 12-lead tracing (though a bit difficult to make out given suboptimal quality). Nevertheless - there is sinus bradycardia at ~50/minute with 1st degree AV block and complete LBBB. In addition - there is definite inferior ST elevatation (lead III > II) - with reciprocal ST depression in aVL. In addition - there are primary ST changes in V4,V5,V6 - all suggesting a proximal RCA lesion in a patient with a left-dominant circulation - so urgent PCI in this hypotensive patient large evolving acute MI. Pacing may soon be needed (complete LBBB plus 1st degree). VERY INTERESTING tracing - THANKS for posting!
ReplyDeleteFor anyone interested in a user-friendly guide for determining what is the likely culprit artery (as well as likely conduction defects from various MIs) - GO TO: https://www.kg-ekgpress.com/ecg_-_coronary_anatomy-mi_localization/
1st degree HB and inferior MI
ReplyDelete