the case.
76 year old male presents to ED with 2 hours of retrosternal chest pain. He is clammy, diaphoretic & looks miserable.
He has a past history of ischaemic heart disease “with a stent” & reports stopping his clopidogrel a week ago to facilitate a gastroscopy/colonoscopy.
This is his ECG…
[DDET Describe & interpret his ECG…]
- Rate.
- ~ 84 bpm.
- Rhythm.
- Regular → sinus.
- Axis.
- -50* [therefore, LAD]
- Intervals.
- PR ~ 120 msec
- QRS ~ 140 msec
- QTc ~ 440 msec
- Segments.
- ST elevation: V2-6 + I & aVL. [Max 3mm, V3].
- ST depression: II, III & aVF [~3mm].
- Others.
- RBBB pattern
- Atrial ectopics (Beats 6 & 8) ?compensatory pauses.
Interpretation.
Acute anterolateral STEMI with right bundle branch block & reciprocal inferior ST depression
This patient meets reperfusion criteria (thrombolysis or PCI).
[/DDET]
[DDET Recall the complications that frequently follow this type of infarct…]
[/DDET]
[DDET The outcome…]
Our cardiology team obligingly take our patient to the Cath lab…
Angiography report.
- 100% LAD (origin) lesion
- Previous drug-eluted stent (LAD).
- Late stent thrombosis (post clopidogrel withdrawal)
- Thrombectomy performed…
…it was here they plucked this from his LAD !!
Stent thrombosis
[/DDET]
[DDET End note]
This was truly a ‘quick case’ with no secrets and tricks.
I saw it mainly as an opportunity to share another great ECG & a rare opportunity of ‘therapeutic followup’ – ie. the clot in the bucket photo !!
Hope it was helpful….
[/DDET]
Dr Chris Partyka MBBS, BMedSci, MD. Staff Specialist in Emergency Medicine, Royal North Shore Hospital. Prehospital and Retrieval Specialist, NSW Ambulance. Clinical Lecturer, University of Sydney
