Cardiologist declines taking patient to the cath lab. Patient dies.

Sent by anonymous, written by Pendell MeyersA middle aged man presented with acute shortness of breath. Apparently he denied chest pain. Here is his first ED ECG:What do you see?Findings: - Sinus tachycardia - Poor R wave progression - STD in leads V3 and V4 - there is almost an appearance of STE in V6, but it is not definite - there is also slight STE in aVL with slight reciprocal STD in inferior leads Impression: Diagnostic of posterior OMI [and the subtle lateral involvement (aVL) supports this] until proven otherwise. STD maximal in V1-V4 (in this case V3-V4) is in my opinion the single best way to identify posterior OMI on the anterior 12 lead ECG. As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath.His first troponin returned " elevated " (level not available). Another ECG was recorded based on the elevated troponin and ongoing symptoms:The heart rate is slightly lower. The posterior and lateral OMI findings persist, with STD maximal in V3 and V4.The provider contacted cardiology to discuss the case, but cardiology " didn ' t think it was a STEMI, didn ' t think he needed emergent cath. "He was admitted to the cardiology floor and diagnosed with an NSTEMI. About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. Like other cases on this...

Source: Dr. Smith's ECG Blog - October 11, 2020 Category: Cardiology Authors: Pendell Source Type: blogs