ECG Interpretation Case 5

A 51 year old male came to the ED with ongoing chest pain  since 4 hours.
There is no past medical history.
No history of Smoking and alcohol intake.
Vitals
B.P 130/70 mmHg
H.R 90/min
The ECG is displayed below.
Interpret the ECG and leave your comments in the box below.

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ECG Interpretation Case 4

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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Which of the following will be the most appropriate initial therapy?

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A 50 year old gentleman is admitted to the CCU with an acute Inferior wall infarction. Three hours after the admission his B.P is 90/50 mmHg. The heart rate is 38 beats per minute with sinus rhythm. Which of the following will be the most appropriate initial therapy?

Immediate insertion of temporary pacemaker

Intravenous administration of of Isoproterenol 5 micrograms/min

Intravenous administration of Dobutamine 0.35 mg/min

Administration of Intravenous Normal saline, 300 ml over 15 mins

Intravenous administration of atropine sulfate , 0.6 mg

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Which of the following laboratory results would be expected?

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A 50 year old gentleman with a history of hypertension and high cholesterol presents to the emergency department with pain in chest for one hour. He describes a substernal chest pressure associated with shortness of breath and sweating. His ECG shows ST elevations consistent with myocardial infarction. Which of the following laboratory results would be expected?

 Elevated myoglobin, normal troponin I, and normal CK-MB

Normal myoglobin, elevated troponin I, and normal CK-MB

Normal myoglobin, normal troponin I, and elevated CK-MB

Normal myoglobin, normal troponin I, and normal CK-MB

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