EKG of the Week 2016 9-18

This EKG comes courtesy of our recent grad Dr. Carlos Penaherrera.

A 51 year old male with a history only of HTN, presented to the ED complaining of chest pain x 1 hr. It was described as aching and pressure, and it was associated with numbness to bilateral arms.  Troponin was negative.

The initial EKG is below.

1.      What does the EKG demonstrate?

2.      What short-term complications can occur in this patient?

 

ANSWER:

The EKG shows ST depressions in leads V3-V6 as well as II and aVF.

Patients with cardiac ischemia are at risk for several complications including arrhythmias, ventricular fibrillation and ventricular tachycardia.

The EKG demonstrates ST depressions in the lateral wall as well as the inferior wall. ST depressions can be a sign of primary ischemia in that wall of the heart. It can also be a reciprocal change reflecting an ST elevation MI in the opposite wall. When ST depressions are noted on EKG, all other leads should be scrutinized looking for ST elevations.

This patient was treated with anti-platelet agents (aspirin and Clopidogrel) as well as anticoagulation. Approximately two hours later the patient went into cardiac arrest and was noted to be in V-fib. He was defibrillated and successfully resuscitated.

V-fib is a known risk of acute MI. This patient developed V-fib despite not manifesting ST elevations on his EKG.

The patient was taken to cath and found to have a 100% mid LAD occlusion. His ejection fraction was 25%. He was successfully stented and required a balloon pump for pressure support. This is the patient’s EKG after the cath.

His EKG continued to improve over the next few days. He was discharged from the hospital on day #5 with an EF of 55%.