Massive ST Elevation After V Fib Arrest, Discordant Bedside Echo Results

A woman in her 40's was brought the ED (not by ambulance) for what is believed to be a seizure.  She was reportedly very anxious and there was a question of benzodiazepine withdrawal.  Events are uncertain (perhaps there was another seizure?), but soon thereafter, the patient was found limp and pulseless, and was found to be in ventricular fibrillation.  She underwent immediate resuscitation with chest compressions (LUCAS and ResQPod).  She was given a total of 3-4 shocks, vasopressin, bicarb x 2 and Epinephrine and, after 10 minutes on LUCAS she had ROSC and was noted to be moving on the cart. An ECG was recorded:Massive anterior, lateral, and inferior ST elevation, with bizarre morphology.  What kind of STEMI is this?The cath lab was activated. An ED Bedside Echo was performed:This subcostal view shows excellent LV function, at least at the apex.  However, there appears to be less than perfect contractility of the base, so this could be Reverse Takotsubo.  Also notice the profoundly hypertrophied LV walls.  This is massive concentric LVH, which in an ischemic condition can lead to very bizarre ECG abnormalities.This parasternal short axis view shows excellent ejection fraction and excellent wall motion at the cross sectional area imaged, but we do not have here a short axis video of the base, which on the above ECG appears possibly to not be contracting well.  Note again the profound concentric LVH (very thick LV walls). In any c...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs