Prehospital Cath Lab Activation for inferior STEMI -- do you agree?
A 40-something male complained of 3 days of chest pressure. He called 911. He had some pulmonary edema and hypoxia.Here is the prehospital ECG:The computer says ***STEMI***Based on this and the presence of chest pain, the medics did a prehospital activation of the cath lab.What do you think?Interpretation: There is clear atrial flutter.Look at the spikes in V1 at a rate over 300, which are flutter waves. The flutter wave in the inferior leads mimics ST Elevation. An ED ECG was recorded:Confirmed Atrial FlutterAgain, notice the flutter waves manifest are sharp spikes in V1There is 2:1 conduction.The atrial rate is over 300, with a ventricular response at a bit over 150The cath lab activation was cancelled and the patient was electrically cardioverted.Here is the post cardioversion ECG:Sinus tachycardiaLook at the P-wavesNotice the very large upright AND inverted portions of the P-wave in lead V1. Notice also the large P-wave in lead II. These features indicate right and left atrial enlargement and explain the pronounced size of the atrial flutter spike in V1 during flutter.
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Steve Smith Source Type: blogs