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EKG Challenge – October 2018

Resident Author: Jennifer Rabjohns, MD
Faculty Mentors: Randy Myers, Massoud Kazzi
Date of Presentation: 10/31/2018

Introduction: 34yoM, h/o DM, p/w chest pain.
EKG at 7:10pm:

What's the differential? 
We discussed big T waves in a prior challenge, here.

Note this is likely not a pericarditis given the inferior ST/TW reciprocal changes.

Serial EKG's were obtained. EKG at 7:25pm:

EKG at 7:31pm:

What is the management?
Have a high suspicion and follow your ACLS guidelines for ACS.

What happened to this patient?
Cardiology was contacted after the first EKG, so they could be ready to activate the cath lab if needed. After the third EKG, a cath attack was called. This patient was shown to have diffuse disease, w/ stent placed to LAD and CABG scheduled for the next day.

Take Home Points

  • STEMI's happen in 34 year olds.
  • Get in touch with cardiology early if you have a high suspicion and/or want a second opinion for EKG's.
  • If you're at all suspicious, get serial EKG's (q5-10min or continuous). This is the recommendation in the ACC/AHA Guidelines for the Management of Patients with STEMI.


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