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A 60 year old female is sent to the emergency department from the clinic for dyspnea on exertion and chest pain for 2 hours. She has a history of type II diabetes, hypertension and dyslipidemia. An EKG from 5 months ago shows normal sinus rhythm. She has had no illness in the past 5 months. What does the EKG show and what is your diagnosis? Rate: 65 Rhythm: sinus rhythm Axis: left axis PR: 0.25 QRS: 0.13 ST: 1 mm ST elevation V3 EKG Diagnosis: Left Bundle Branch Block (LBBB), Left atrial enlargement, and 1st degree AV block Clinical Diagnosis: New onset symptomatic LBBB r/o acute MI Treatment: New LBBB is highly suspicious for occlusion of the septal branch of the left anterior descending artery and therefore acute MI must be ruled out with serial troponins and EKG’s. This patient would require nitroglycerin, oxygen, aspirin, morphine, PCI or thrombolytics. |