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Crossword Puzzles: |
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A 64 year old male presents to the emergency department complaining of crushing pressure like chest pain, radiating to his left arm and neck which started 3 hours prior. The pain is worse than his typical angina and is not relieved by nitroglycerin. You contact his PMD, who informs you that he had a stent placed last year, as well as a PMH of DM, HTN, diabetic retinopathy, and a small cerebral infarct 9 months ago. He also reports that the patients’ EKG last week was normal which you confirm by fax. Cardiology and cardiac catheterization are not available. CXR and physical exam are normal. What does the EKG show and what is the diagnosis? Rate: 54 Rhythm: sinus bradycardia Axis: left axis PR: normal QRS: wide ST: T inversion in I, AVL, V3-V6 EKG diagnosis: Sinus bradycardia with LBBB Clinical diagnosis: Sinus bradycardia with a new LBBB, most likely secondary to acute myocardial infarction Treatment: Aspirin, nitroglycerin, oxygen, morphine (MONA) -Hold beta blockers secondary to bradycardia -consider giving heparin and IIb/IIIa inhibitor -Do not thrombolyse due to history of CVA within past year What are the indications for thrombolysis (specifically time to treatment, ST elevation height and EKG changes)? -Less than 6-12 hours of symptom onset -Symptoms compatible with acute MI -EKG changes with:
What are the five “absolute contraindications” to thrombolysis (as per Tintinalli)? -Previous hemorrhagic stroke at any time -Any CVA in the past year -Known intracranial neoplasm -Active internal bleeding (excluding menses) -Suspected aortic dissection or pericarditis
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