Thursday, June 19, 2014

Next Step in Management?

This EKG is from an elderly woman with a known old left bundle branch block presenting with shortness of breath. You recall your medical school teaching that if someone has an old LBBB, subsequent EKGs cannot be interpreted.

Challenge: What is your interpretation of this EKG? What is the next step in management?

Image shown under Fair Use.


city said...

inferior territory ischemia. ACS protocol

Craig Chen said...

yes - good call!
Next Step in Management?

The EKG shown demonstrates sinus bradycardia, left bundle branch block, and primary ST-T changes. Look at leads 2, 3, and F and note the biphasic and inverted T's. These are consistent with primary ST-T changes. In an old uncomplicated LBBB, the secondary T waves should have a direction opposite the major vector of the QRS; you would expect her old EKG to show upright T's in the inferior leads. This patient should be treated as an acute inferior MI and go to the cath lab.

Source: ECG Wave Maven