A man in his 80s with chest pain

Written by Pendell MeyersA male in his 80s with history of colon cancer, HTN, and CAD with a newly placed LAD stent approximately 1 month ago, presenting with acute shortness of breath and chest pain. No prior ECG.Here is his ECG at 07:08:There is STE in V2, I and aVL, but it does not meet STEMI criteria because there are no two contiguous leads with STE meeting criteria. There is also STD in V3-V6, as well as II, III, and aVF. There is likely lead misplacement involving V2 explaining the R-wave progression. These findings and their associated morphology are definite evidence of transmural ischemia of the anterior and lateral walls, most commonly due to OMI. This distribution would sometimes be seen with a large first diagonal, however we have prior knowledge that the patient just had a proximal LAD stent placed, making this site very likely and also consistent with the pattern above. The cath lab was activated.By the time the cardiologist arrived, the patient started to deteriorate rapidly. He was in acute, profound cardiogenic shock. He never had VF/VT, but instead became bradycardic and hypotensive quickly before suffering PEA arrest.Here is his last available ECG prior to arrest at 07:29:There is new RBBB and LAFB (the prior ECG shows similar frontal plane axis, but is now wider qualifying for LAFB). This is a very bad prognostic sign of LAD occlusion. This ECG may be barely positive for STEMI criteria with 1mm STE in lead I.CPR and ACLS were initiated without respon...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs