Case #1 reveals an underlying sinus rhythm.
Without knowing patient history or presentation, the ST segment elevations in leads I, aVL in addition to
ST elevation in V1-V3 indicate an anterior wall myocardial infarction. AMI's typically involve occlusion or
injury to the left anterior descending artery or its branches. Also of note are the reciprocal changes in leads
II, III, and aVF which assist the clinician in the preliminary EKG diagnosis.
Case #2 reveals a baseline sinus rhythm. R wave progression in the precordial
leads appears maintained, but
ST segment elevations are observed in leads II, III, and aVF. Reciprocal changes are present in leads I and aVL.
These EKG changes are consistent with an inferior wall MI. When treating ischemic pain likely from an inferior
wall infarction, it is advisable to utilize IV fluids. Patients suffering from this condition who receive nitrates are
at risk for profound hypotension post administration. Inferior wall MI's can also present with various blocks and
bradydysrhythmias. The right coronary artery and its branches supply many of the heart's conductive pathways.
Comments? Please email:
Ben Lawner, NREMT-P, MS-II