Case: 62 year old man attends emergency department with shortness of breath and recurrent episodes of syncope. He is known to have chronic obstructive pulmonary disease (COPD) and has smoked heavily for 40 years. All we know about his medications so far is that he takes something for his blood pressure and has inhalers for his COPD. He does not normally require O2 at home. He is currently pyrexial. His blood pressure is 110/70, he is normally hypertensive. He is tachycardic with an irregular pulse. Arterial blood gas shows a mixed respiratory and metabolic acidosis. His saturations are 85% on 15L of O2. You do an ECG which shows the following: I have provided a case to go with this ECG for completeness. What does this ECG show? (Please click on the image to see it in full size).
Anteroseptal MI + lateral wall ischemia in the setting of A fib ( not sure ) with variable block ( demonstrated by the varying rhythm ) witha component of fasicular block. Really nice one, thanks and educate me further
Atrial fibrilation + Left ventricular hypertrophy + probable NSTEMI / Myocardial Ischemia / PE i'd take troponin I and T levels, LDH, myoglobin and BNP i could not differentiate this from PE or MI without labs, or anything more than "shortness of breath". That ST elevation does not convince me, a real MI usually doesn't make you count the Ashman units, they tend to be very straightforward, yet this oculd be NSTEMI or Unstable angina (which would be weird without previous episodes). PE: pulmonary embolism NSTEMI: Non-St elevation myocardial infarction BNP: brain natriuretic peptide LDH; lactate dehydrogenase
LVH and Uncontrolled Atrial Fib. Controlling his rate may help with the dyspnea and syncopal episodes. You could try Diltiazem or do a TEE to ensure there are no clots and Sync Cardioversion (if he is already anti coagulated)
