Acute coronary s-m Cat LAB

In any emergency department , there is ava of ECG machine do the ECG first as screening tool for Chest pain it will tell that chest pain is cardiac origin or not. Take the expert opinion from cardiologist , even simple emergency physicians will make the diagnosis and Do the needful Treatment if cardiologist facility is not available

Alok Kumar Bharti I'm sorry doctor for asking, I took a great electrocardiogram course but I had several doubts due to the patient's healthy history

Definitely you will know more about ECG but Patient history warrant for ECG as screening

Hello Thiago Soethe Ramos

I would have agreed with Dr Alok Kumar Bharti that ECG is useful at initial presentation as a screening tool. Do you have more information now from further diagnostic testing?

Besides ECG , we can think of differential of Chest pain like tension pneumothorax, cardiac tamponade, Aortic dissection , severe gastritis or peptic ulcer and investigate accordingly

The ECG is consistent with an acute inferior wall myocardial infarction (ST elevation in leads II, III, and aVF) with inclusion of the apex of the left ventricle (ST elevation in leads V5 and V6). Given the patient's history and this ECG I would initiate the STEMI protocol if you have one. I would probably do V3R and V4R leads to see if there is also injury to the right ventricle which will help guide the therapeutic approach if you are not taking the patient for PCI right away.

Here are some helps for your future practice in EKGs and what to do. Dr Mattu has written several ECG/EKG books with the ED physician practice in mind. The other two are basic use EKG interpretation books which can be a good start. The AHA/ACC guidelines for chest pain and STEMI have helpful guidance as well. There are lots of quick EKG courses out on the internet which can provide resource and practice on looking as EKGs.

Ecgs for the Emergency Physician 1 by Amal Mattu

Rapid Interpretation of EKG's, Sixth Edition 6th Revised ed. Edition by Dale Dubin (Author)

The Only EKG Book You’ll Ever Need Tenth, North American Edition by Malcolm S. Thaler (Author)

021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Gulati M, Levy PD, Mukherjee D, et al. Circulation Volume 144, Issue 22, 30 November 2021; Pages e368-e454 https://doi.org/10.1161/CIR.0000000000001029

https://www.jacc.org/doi/10.1016/j.jacc.2021.07.053?_ga=2.41749035.808535900.1703775444-254510693.1702050652

healio.com/cardiology/learn-the-heart/ecg-review/ecg-interpretation-tutorial/stemi-mi-ecg-pattern

По ЭКГ вероятно ОКС с подъемом сегмента ST с поражением нижней стенки (элевация ST в III, aVF, реципрокные изменения в I, aVL). Необходимо соотнести с длительностью болей и результатами тропонин-теста.

ECG is suggestive of Inferior wall MI indicating RCA blockage . Serial ECG is mandatory for such type of case Inform cardiologist immediately they will manage patient either medically or PCI.

This is a case of STEMI. immediate Reperfusion therapy is choice

ST elevation Inf leads (II, III, aVF)

Reciprocal depression lateral leads (I & aVL)

Poor R wave progression chest leads which you can get if this is a Right sided ECG

ST elevation III > ST elevation II

This could be a right ventricular myocardial infarction (mortality 23% - 53% compared with 4.8% (in inf MI in Ireland)

If this is not a right sided ECG, one should be done unless you have a cath lab on site.

I wish you all the best

Richard

Reba McVay EXCELLENT, DOCTOR'S GUIDELINES, I WILL TRY TO STUDY ALL OF THEM AS SOON AS POSSIBLE. WOULD I LIKE TO ASK FOR YOUR AUTHORIZATION TO POST YOUR RECOMMENDATIONS ON MY INSTAGRAM AND FACEBOOK SO THAT MY COLLEGE COLLEAGUES CAN BENEFIT FROM YOUR VALUABLE TIPS?

BY THE WAY, I HAVE ALREADY TAKEN AN INTENSIVE ECG COURSE (WITH AN EXCELLENT DOCTOR FROM Johns Hopkins), TWO OTHERS WITH AN OXFORD PROFESSOR ON /'Hemodynamic Assessment of Cardiac Function' AND 'Cardiovascular Physiology and Pathophysiology', AND ANOTHER ON 'CARDIOVASCULAR DISORDERS IN PEDIATRICS AND NEONATAL INTENSIVE CARE'

CARDIOLOGY WAS MY FIRST ROMANCE IN THE MEDICAL UNIVERSE, AND MY FIRST NIGHTMARE SINCE MY NIECE WAS BORN WITH 4 ASSOCIATED CONGENITAL HEART DISEASES

Acute coronary s-m Posterior wall infarction

Absolutely! Please share.

Ecg finding indicating Inferior wall MI

doctors, next Wednesday, the patient will take the exams and I will give you feedback

Serial ECG is mandatory in pain of cardiac origin and also look for Reciprocal changes in ECG for better managemet in totality

Acute coronary syndrm

ECG is screening tool for any patients having cardia origin Chest pain . ECG indicating Inferior wall MI