I have noticed in the first case ECG that there is some ST depression in V2 & V3, Do you agree?
What do you think about this from the STEMI vs pericarditis point of view?
This makes me want to change my practice and preform a bedside ultrasound on all STEMIs before I administer thrombolytics regardless of the ECG findings. Great cases. Thanks for sharing.
Hesham,
There’s just a tiny bit of ST depression….less than a 1/2 mm. I’m not sure what to make of that. Normally if I clearly see ST depression, I feel that it strongly rules out pericarditis and points toward true STEMI, but this is so small, I’m not sure I would make a definitive decision based on that. Also, then, you’ve got the Spodick sign to deal with, and some PR depressions. It’s not easy, and very easy to talk yourself into or out of something. But the key here, and in the other cases, is much more simple: LV + tachy = pericardial effusion until proven otherwise. Take a look with the U/S or even a dry CT.
Jonathan,
I would probably only routinely do the u/s before lytics if I saw LV, but it certainly would be reasonably to do a (quick!) u/s in all of your presumed STEMI patients before lytics, as long as you aren’t delaying things too much.
Thanks everyone.
Amal
Drawing the arms on that guy really made the drawing come together. I am 99% sure that was Baymax from Big Hero 6 and he definitely has arms LOL. This episode was a classic. I like the simple take home and will definitely use this in the future. Thanks!
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Dear Dr Mattu,
Great leaning session as usual.
I have noticed in the first case ECG that there is some ST depression in V2 & V3, Do you agree?
What do you think about this from the STEMI vs pericarditis point of view?
Regards,
Hesham
Thank you.
thank you.quite a revelation
Thank you for this presentation!
This makes me want to change my practice and preform a bedside ultrasound on all STEMIs before I administer thrombolytics regardless of the ECG findings. Great cases. Thanks for sharing.
Thanks Amal.
Good.will definitely be helpful.
Excellent case review!!!!
Great cases
Thank you Dr.Amal
Love the new site, Amal. Easier to follow.
Jim Jones, Texas
Hesham,
There’s just a tiny bit of ST depression….less than a 1/2 mm. I’m not sure what to make of that. Normally if I clearly see ST depression, I feel that it strongly rules out pericarditis and points toward true STEMI, but this is so small, I’m not sure I would make a definitive decision based on that. Also, then, you’ve got the Spodick sign to deal with, and some PR depressions. It’s not easy, and very easy to talk yourself into or out of something. But the key here, and in the other cases, is much more simple: LV + tachy = pericardial effusion until proven otherwise. Take a look with the U/S or even a dry CT.
Jonathan,
I would probably only routinely do the u/s before lytics if I saw LV, but it certainly would be reasonably to do a (quick!) u/s in all of your presumed STEMI patients before lytics, as long as you aren’t delaying things too much.
Thanks everyone.
Amal
Drawing the arms on that guy really made the drawing come together. I am 99% sure that was Baymax from Big Hero 6 and he definitely has arms LOL. This episode was a classic. I like the simple take home and will definitely use this in the future. Thanks!
hey, good point about Baymax! No doubt he has low voltage also!