Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics

A 61 year old male presents to the emergency department within 7 hours of onset of a substernal chest pain that waxes and wanes in intensity.  He has never had such pain before and has an active lifestyle.  He worked as a plumber and smokes 20 cigarettes a day.

Rate:  100-110

Rhythm:  Sinus rhythm

Axis:  Normal

P:   Normal

PR:  Normal

QRS:   Normal

QT:  Normal

ST:  Gross depression I, II, AVF, V2-V6

EKG diagnosis: Widespread ST depression consistent with myocardial ischemia

Clinical diagnosis: Unstable angina

• Practice Points: - ST depression has many causes including myocardial ischemia, digoxin effect, left ventricular hypertrophy, bundle branch blocks, myocarditis, cardiomyopathy, or it can be a reciprocal change related to ST elevation elsewhere in the EKG.
• -ST depression which is horizontal is strongly suggestive of myocardial ischemia or of subendocardial infarction.
• -The diagnosis is straightforward in the context of the clinical history.
• -With appropriate treatment (aspirin, heparin, and nitrates) the ST segments rapidly improved.

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