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January EKG 2006 Answer Key

January 2006 EKG Quiz Due 1/31/2006

A 42 year old male presents with a complaint of epigastric discomfort, nausea, and vomiting for the past 4 hours. The symptoms started while driving his family back from a fast food restaurant. No one else in his family has symptoms. He does not complain of chest pain or shortness of breath. He used Maalox without relief. His vital signs are: BP: 130/75 RR: 18 T: 98.2 SaO2: 98% on room air

What does the EKG show?

Rate: 53

Rhythm: complete AV dissociation

Axis: normal

PR: variable

ST: elevated in II, III, and aVF; depressed in I, aVL, V1, and V2

QRS: narrow complex, Q in II, III, and aVF

EKG diagnosis: 1) Inferior wall myocardial infarction with Q waves

    • 2) 3rd degree AV block
  • Clinical diagnosis: Nausea and vomiting secondary to acute myocardial infarction

    • Treatment: -Cardiac monitoring, IV access (+/-) fluids, oxygen, aspirin, nitrates, (+/-) morphine (no chest pain).

        • · -Thrombolytics vs. PTCA (depending on institution)
        • · -No beta blockers ( heart rate is already at target and the patient has 3rd degree heart block and inferior wall MI has increased vagal tone)
        • · -Pacemaker at bedside (3rd degree heart block is usually transient in inferior wall MI, stable narrow complex QRS from AV node)

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