Just Plain Ruff Posted January 24, 2009 Posted January 24, 2009 I had a difficult case this morning. 90 year old female, chest pain, short of breath, high high fever (103.0) and the following rhythm strips. if the strips don't show up then I apologize and I can send them to you. But she was no non-descript on the chest pain and the EKG was something I haven't seen in a while so I was very on the fence with either transferring her to a cardiac center of just bringing her to our ER. I've never been one to 2nd guess myself but I ended up flying her with the initial diagnosis of a MI but this was one of those cases where my GUT told me one thing yet logic said otherwise. If anyone can help me and have these strips show up in the post please point me in the right direction on how to do this. thanks Here are the strips http://s4.photobucket.com/albums/y136/ruffems/SCAN0001.jpg http://s4.photobucket.com/albums/y136/ruffems/SCAN0002.jpg
CTXMEDIC Posted January 24, 2009 Posted January 24, 2009 links arent workin bro. we're getting like 15,000 emtcity pages openeing with each link. i know what happened. yopu clicked the link to your album not the link to the pic. try it again...
Just Plain Ruff Posted January 25, 2009 Author Posted January 25, 2009 fixed I believe. I can now see the image. I guess my question on this whole thing is this, What is the true significance of left ventricular hypertrophy and MI and what ramifications are there when you have both present at the same time. thanks for your help.
CTXMEDIC Posted January 25, 2009 Posted January 25, 2009 In LVH, the significance is that theyre going to have a poor ejection fraction. Did you check a V4R on this? Also i notice her sats were 88%. what else can you tell us about her? To continue... LVH (CHF) shes going to have pulmonary edema due to the inability, or reduced effectiveness, of the left heart to push oxygenated blood to the body. with a right infarct, depending on the severity, the right heart wont be able to push de-oxygenated blood to the lungs. so basically you have a total failure.
Just Plain Ruff Posted January 25, 2009 Author Posted January 25, 2009 90 year old, speaks little to no english so history is crappy I did a right sided EKG and all leads look the same but V4R was NOT elevated. pulse ox increased to 96% on 4lpm oxy gave her 4 baby asa, IV, monitor, BP 160/80 or so I don't have the vitals in front of me. I was unable to find a previous EKG from our hospital records so I have none to compare it to.
Just Plain Ruff Posted January 25, 2009 Author Posted January 25, 2009 In LVH, the significance is that theyre going to have a poor ejection fraction. Did you check a V4R on this? Also i notice her sats were 88%. what else can you tell us about her? I did find an article from Circulation that said that Left Ventricular Hypertrophy can mask an Inferior/lateral MI. I guess I have some research to do
CTXMEDIC Posted January 25, 2009 Posted January 25, 2009 I did find an article from Circulation that said that Left Ventricular Hypertrophy can mask an Inferior/lateral MI. I guess I have some research to do true. theoretically, LVH on a 12 lead renders it 'non-diagnostic'. some info can still be gleaned from it although blocks may be hard to distinguish. interesting she just had an inferior MI. woulda bet money she had an RVI goin on.
Just Plain Ruff Posted January 25, 2009 Author Posted January 25, 2009 well her pressure was good. But she really after talking with her much more with her grandson as a translator sinc of course she doesnt' speak a lick of english the pain was really not chest pain but pain on inspiration. So I ruled out nitro. Maybe that wasn't the right decision but I didn't feel comfortable with nitro. Plus, isn't nitro contraindicated in the presence of a RVI? I have no more information on this lady until I get back to work on wednesday night since I'm off work till then.
CTXMEDIC Posted January 25, 2009 Posted January 25, 2009 It would be interesting to follow up on her. And yeah, nitro isnt the best thing for a RVI but you can still give it. I wouldnt do it unless i had a good line in and a stable pressure. It looks like shes having an inferolateral AMI though due to elevation in your II, III, aVF, v3 and v4.
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