Guess the EKG.

[Aidey]

It isn't what you think it is.

 

[NYMedic828]

Pericarditis.

(All I can see from my phone is diffuse elevations in almost all leads)

 

[Aidey]

Nope.

 

[NomadicMedic]

Early repolarization?

The R waves are progessing in size, no reciprocal changes and the ST segment is upwardly concave.

 

[Merck]

Well it looks like a inf/lateral STEMI. Give the II/III ratio and appearance of I it suggests a left Cx occlusion. Differentials would include occlusion due to thrombosis or coronary aneurysm and ventricular anuerysm/apical ballooning (i.e. takotsubo). If it's something more esoteric like a weird myocarditis/pericarditis then there's not much you can do about that.

 

[Aidey]

Damn, we have a winner already.

Takotsubo's. Although it wasn't figured out until after the pt got out of the cath lab, where they found 100% clean coronary arteries. Our MD called it an inferior-lateral with possible posterior extension prior to the cath results coming back.

 

[NYMedic828]

Well it looks like a inf/lateral STEMI. Give the II/III ratio and appearance of I it suggests a left Cx occlusion. Differentials would include occlusion due to thrombosis or coronary aneurysm and ventricular anuerysm/apical ballooning (i.e. takotsubo). If it's something more esoteric like a weird myocarditis/pericarditis then there's not much you can do about that.

:huh:

I quit.

 

[NomadicMedic]

:huh:

I quit.

Me too.

 

[Merck]

Just how we roll up in BC, Canada boys

Good case, I'd be curious to know the pt particulars as well. I've only seen a couple but they were interesting because they had the classic signs of being a young female with ST changes. Apparently you can get some good pulmonary edema as well (which makes sense) but haven't seen that.

Cheers.

 

[Aidey]

75 year old female, running to catch the bus, started feeling dizzy/light headed and nauseous and had a near syncopal episode. Laid down on a bus bench and bystanders dumped water on her and fanned her to cool her off. By the time we arrived she said the nausea had resolved after she laid down, and she was still feeling dizzy, but it wasn't as bad.

No history, no surgeries, no meds, no allergies. Healthy, and looked at least 10 years younger than she was. No chest pain, no SOB, no on going nausea. Only symptom was continued dizziness.

 

[Merck]

Interesting. Bet ya won't see that again anytime soon. That's an easy nitro, asa, plavix, +/- analgesia and off to the cath lab though. Until I get my tri-corder anyway.

 

[shfd739]

I hadn't heard of takotsubo until a few weeks.

Patient was being discharged post a severe enough case it sent her into massive heart failure.

 

[EMSrush]

I had never heard of this before. Very interesting case. Thanks for sharing, Aidey.

 

[Aidey]

You guys are killing me. Takotsubo's is the other name for stress induced cardiomyopathy.

 

[EMSrush]

You guys are killing me. Takotsubo's is the other name for stress induced cardiomyopathy.

Hey, learn something new every day.

 

[shfd739]

Hey, learn something new every day.

Yep. I'd heard of stress induced myopathy.

Didn't know it had a fancy name until a few weeks ago.

 

[NYMedic828]

I understand what part of the ECG in particular directed you to immediately know it was such a random condition :sad:

 

[EMSrush]

Takotsubo's is the other name for stress induced cardiomyopathy.

I would have assumed it was some type of sushi...

 

[Aidey]

I understand what part of the ECG in particular directed you to immediately know it was such a random condition :sad:

Me? I didn't have a bloody clue until I heard from the doc after the cath lab results came back. Although apparently anytime an EKG shows massive left ventricular dysfunction it is a possibility.

 

[NYMedic828]

Me? I didn't have a bloody clue until I heard from the doc after the cath lab results came back. Although apparently anytime an EKG shows massive left ventricular dysfunction it is a possibility.

I was more gearing my questions towards supermedic...errr.. i mean Merck.

Freaking smart Canadians :glare: