You have two hours to save this patient ' s life

Written by Pendell Meyers, edits by Steve SmithA female in her 60s with history of CAD s/p PCI and CABG, alcohol abuse, and recurrent pancreatitis presented at 14:55 complaining of sudden onset epigastric pain. Initial vital signs were heart rate 44 bpm, respiratory rate 16, BP 143/67, SpO2 96% on room air. On initial exam she was in mild distress and complaining of severe nausea.Here is her initial ECG:What do you think?There is decreased ECG quality due to baseline movement. Despite this, there are clearly hyperacute T-waves in lead III with reciprocal negative hyperacute T-waves in aVL (and lead I) with likely a small amount of STD in aVL. This is diagnostic of acute transmural inferior acute MI, with the most likely etiology being acute coronary occlusion. There is clear STD in V2 indicative of posterior involvement. Sinus bradycardia despite critical illness also points toward inferior acute coronary occlusion (as the SA and AV node are generally supplied by the same vessel as the inferior wall).Here are two immediate repeat ECGs performed in efforts to get less baseline wander and artifact:The same findings are evident throughout, but with baseline movement obscuring various sections. There is even a very small amount of STE present in III on the third ECG.The emergency physicians activated the cath lab. Apparently this decision was made only on perceived STE in lead III on the last of the ECGs above.This happened to have been the 6th emergent cath lab activation called...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs