Thanks for participating to Drs. Avula, Sehgal, Trivedi, and Silverman
Case 1: Posterior MI
In severe anterior depressions, commonly may not see reciprocity. Usually, see reciprocal change with more severe findings (E.g. LAD lesions)
Case 2. Anterior MI:
With presence of hyperacute t-wave (peaking T), can call an acute MI with a good story. However, keep in mind hyperkalemia and other causes.
With presence of hyperacute t-wave (peaking T), can call an acute MI with a good story. However, keep in mind hyperkalemia and other causes.
In any MI, consider lytics if there is at least 30 minutes delay in going to cath. This decision should be made also based on duration of symptoms: -the earlier in the course of pain, the better thrombolytics work, and the more early reperfusion benefit there is
Case 3. dynamic v3-v5 changes
In cases of anterior MI (LAD) you'd expect distal occlusion : should see incremental ST elevation from V1-V6, also no reciprocal change. The case pattern could also be seen with occluded diagonal lesion.
Please consider an echo if a borderline case AND immediately available--questionable and debated even within cardiology group between interventionalists and non-interventionalists.
Some specific non-case related points:
- early cath may save money, radiation--does not have to be STEMI. If presentation is concerning, notify cardiologist and do not document EKG as STEMI.
- Early repolarization is now being reevaluated: may not be benign ever, but is possible in older people. It may be dynamic due to autonomic innervation of the heart.
- consider atrial flutter if the rate is about 140-150
Please, save interesting STEMI-eligible cases for next STEMI conference on 2/14/2012
Thanks!