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Orthopedics

This is a 58 year old male who complains of shortness of breath, nausea and shoulder pain for the last 8 hours. He has PMHx of DM, HTN, and is a smoker.

What does the EKG show?

Rate: 98

Rhythm: sinus

Axis: borderline left

PR: normal

QRS: no Q waves, R-wave greater than 0.04 sec in V1 and V2

ST: ST depression in V1-V4 (?V5)

T waves inverted in V1-V4, I and aVL, flat in V5, V6

EKG Diagnosis: Acute posterior wall infarction

Clinical diagnosis: (How did you come to this diagnosis?)

• Chest pain r/o MI (posterior wall) (may get posterior leads)
• Initial R-wave > or = to 0.04 sec in V1 or V2 with R wave amplitude > or = to S wave and significant (2 mm) ST segment depression
• Acute posterior infarction is often associated with EKG changes of acute inferior or inferolateral myocardial infarction, but may occur in isolation

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