Monday, September 28, 2009

Cath Lab?

You're taking home call as the cardiology fellow when your sleep is interrupted by beeping of your fax machine. You get the EKG shown above; darn the quality of those faxed copies! The resident calls with the story: a fifty year old gentleman with hypertension, diabetes, dyslipidemia, and gout presents with several minutes of substernal crushing chest pain radiating to the jaw and left arm. This pain is accompanied by dyspnea, nausea, and diaphoresis. Troponins are negative. The EKG is shown above. Apparently, this man had a perfectly normal EKG one year ago.

Challenge: Do you drive into the hospital to cath this guy? If no, why not? If yes, where is the lesion?

Image is shown under Creative Commons Attribution-ShareAlike 3.0 License.


Craig Chen said...

Cath Lab?

The clinical presentation is classic for an acute myocardial infarction. Troponins may not be initially elevated. While the EKG may show some ST-segment changes, the notable finding is deep T wave inversions in the precordial leads, called "Wellen's Syndrome." The classic location is a stenosis in the left anterior descending coronary artery.

Sources: UpToDate; Wikipedia.

Alex said...

argh, was gonna say "wellen's syndrome" but hesitated