Monday, March 23, 2009

Identification Data-Chest pain

A 40 year old, male, teacher came to the casualty department complaining of chest pain, sudden onset radiating to left shoulder and jaw. He also had a history of being unable to lie flat and shortness of breath after walking for a few steps.

a. State one (1) abnormality of the ST segment shown in the ECG recording
St elevation- lead III, aVF, V3, V4, V5
ST depression- aVL

b. State one (1) other abnormality of the ECG recording shown
Deep Q wave at lead III

c. State the most likely diagnosis
Acute Myocardial Infarction

d. List two (2) other relevant investigations you would do and state your reason

Plasma biochemical marker - to detect any rise in the plasma concentration of enzyme and protein that are normally concentrated within cardiac cells. (in MI- rise in CK-MB, Troponin T and I)

Echocardiography- to check cardiac function and detecting important complication (e.g mural thrombus, cardiac rupture, VSD, mitral regurgitation, pericardial effusion)

~living well or living hell? Fighting for future!~


jade said...

sign of Mi kat ECG..

1st - T-wave inversion ( due to lack of 02 and K+ leak from damaged myocardial muscle cell)

2nd - St segment elevation (>1mm high is considered elevated- compare ngn isoelectric line)
- due to severe injury 2 myocyte
- indicate acute injury.

3rd - pathologic Q wave - irreversible damage
- ( >25% of R wave is consider pathologic)

N.B : if Q wave present, no St elevation --> chronic MI
Treatmen given during ST elevation will give good prognosis. IF Q wave da appear, poor.

(yattaaa~ =) klau salah btuikan la ek...

Miss Independent on March 23, 2009 at 12:56 PM said...


lagi satu, kalau ada ST elevation bole jd gak pericarditis. tp beza dgn MI, kalo pericarditis ST elevation kat sumer lead, kalo MI just certain lead je.

thanks to jade for additional info =)


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