90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important.===================================MY Comment, by KEN GRAUER, MD (11/5/2022):===================================Our thanks to Drs. El-Baba and McLaren — for their presentation in today’s post about an important topic worthy of our periodic reminders. We’ve presented many variations on this theme on Dr. Smith’s Blog — with today’s case being distinguished by its discovery on abdominal exam! Rather than reflexive assumption that diffuse ST depression with ST elevation in lead aVR invariably means acute coronary disease — complete examination of today’s patient revealed abdominal tenderness — that led to the diagnosis of mesenteric ischemia with associated septic shock. One More CASE:As reinforcement of the concepts brought out by Drs. El-Baba and McLaren in today ’s case — Consider the ECG in Figure-1, obtained from an older adult.In view of this ECG — Should the cath lab be activated?Figure-1: ECG obtained from an older adult. Should the cath lab be activated?MY Approach to the ECG in Figure-1:I routinely favor a 2-step approach to ECG interpretation:Step #1 ( = Des...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs